BackgroundCancer cachexia complicates advanced non‐small cell lung cancer (NSCLC); however, it remains unclear how often cachexia occurs and how it affects the course of chemotherapy in patients receiving first‐line systemic therapy.MethodsWe conducted a multicentre, prospective observational study and enrolled previously untreated NSCLC patients with Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0–2 and cachexia between September 2020 and September 2021. The primary outcome measure was the trends in the Functional Assessment of Anorexia/Cachexia Treatment and Anorexia/Cachexia Subscale [FAACT (A/CS)] scores by cohort. Secondary outcome measures included the incidence of cachexia before the initiation of first‐line systemic therapy, quality of life (QOL) measures, body weight (BW) changes, and efficacy and safety of first‐line systemic therapy.ResultsA total of 887 consecutive patients with previously untreated advanced NSCLC and ECOG PS of 0–2 who were initiated on first‐line systemic therapy were evaluated. A total of 281 patients (31.7%) experienced BW loss consistent with the criteria of cachexia, and 186 were evaluated for QOL, BW and outcome measurements. Overall, 180/186 patients received first‐line systemic therapy. Cohort 1 (targeted therapy), cohort 2 [cytotoxic chemotherapy (CTx) ± immune checkpoint inhibitors (ICIs)] and cohort 3 (ICIs) included 42, 98 and 40 patients, respectively. There were significant variations in QOL trends by cohort, with chemotherapy‐associated emesis affecting early appetite‐related QOL. The change in the FAACT (A/CS) score at 1 week from baseline was worse in cohort 2 (the least square mean change ± standard error: −3.0 ± 0.9) than in cohorts 1 (1.6 ± 1.2, p = 0.003) and 3 (1.8 ± 1.0, p = 0.002); meanwhile, the change at 6 weeks was worse in cohort 1 (−1.5 ± 1.2) than in cohorts 2 (3.6 ± 0.9, p = 0.001) and 3 (3.5 ± 1.1, p = 0.004). BW reduction was observed in all cohorts within 6 weeks of therapy initiation. The targeted therapy cohort demonstrated superior progression‐free survival (PFS) and overall survival (OS) to CTx ± ICIs cohort or ICIs cohort (median PFS was 9.7 months, 6.3 months, 3.1 months, in cohort 1, 2, 3, respectively (cohort 1 vs. cohort 2: HR, 0.58, p = 0.018; cohort 1 vs. cohort 3: HR, 0.41, p = 0.001); median OS was not reached, 15.8 months, 9.9 months, respectively (cohort 1 vs. cohort 2: HR, 0.52, p = 0.033; cohort 1 vs. cohort 3: HR, 0.37, p = 0.003).ConclusionsApproximately 1/3 patients with previously untreated advanced NSCLC have cachexia. Appetite‐related QOL trends vary based on the type of first‐line systemic therapy in cachectic NSCLC patients, and the PFS and OS of these patients seemed to be shorter.

中文翻译：

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恶病质和一线系统治疗对先前未经治疗的晚期非小细胞肺癌的影响：NEJ050A


背景癌症恶病质使晚期非小细胞肺癌 (NSCLC) 复杂化；然而，目前尚不清楚恶病质发生的频率以及它如何影响接受一线全身治疗的患者的化疗过程。方法我们进行了一项多中心、前瞻性观察性研究，并入组了先前未经治疗且具有东部肿瘤合作组表现状态（ECOG PS）的非小细胞肺癌患者) 0-2 和恶病质在 2020 年 9 月至 2021 年 9 月之间。主要结果指标是按队列的厌食症/恶病质治疗功能评估和厌食症/恶病质子量表 [FAACT (A/CS)] 评分的趋势。次要结局指标包括开始一线全身治疗前恶病质的发生率、生活质量 (QOL) 指标、体重 (BW) 变化以及一线全身治疗的疗效和安全性。 结果 总共 887 名连续患者对先前未经治疗的晚期 NSCLC 和 ECOG PS 为 0-2 且开始一线全身治疗的患者进行了评估。共有 281 名患者 (31.7%) 经历了符合恶病质标准的体重下降，其中 186 名患者接受了 QOL、BW 和结果测量评估。总体而言，180/186 名患者接受了一线全身治疗。第 1 组（靶向治疗）、第 2 组 [细胞毒性化疗 (CTx) ± 免疫检查点抑制剂 (ICIs)] 和第 3 组 (ICIs) 分别包括 42、98 和 40 名患者。各队列的生活质量趋势存在显着差异，化疗相关的呕吐影响早期食欲相关的生活质量。第 1 周时 FAACT (A/CS) 评分相对于基线的变化在队列 2 中更差（最小二乘均值变化 ± 标准误差：−3.0 ± 0.9），而队列 1 则更差（1.6 ± 1.2，p = 0.003）， 3（1.8 ± 1.0，p = 0。002）；同时，第 1 组 (−1.5 ± 1.2) 在 6 周时的变化比第 2 组 (3.6 ± 0.9，p = 0.001) 和第 3 组 (3.5 ± 1.1，p = 0.004) 更差。治疗开始后 6 周内，所有队列均观察到体重减少。靶向治疗队列表现出优于 CTx ± ICIs 队列或 ICIs 队列的无进展生存期 (PFS) 和总生存期 (OS)（队列 1、2、3 中的中位 PFS 分别为 9.7 个月、6.3 个月、3.1 个月（队列 1 与队列 2：HR，0.58，p = 0.018；队列 1 与队列 3：HR，0.41，p = 0.001）；未达到中位 OS，分别为 15.8 个月和 9.9 个月（队列 1 与队列 3） 2：HR，0.52，p = 0.033；队列 1 与队列 3：HR，0.37，p = 0.003）。结论 约 1/3 的既往未经治疗的晚期 NSCLC 患者患有恶病质，食欲相关的 QOL 趋势因类型而异。恶病质 NSCLC 患者的一线全身治疗，这些患者的 PFS 和 OS 似乎较短。