Association of Pre-treatment Sarcopenia with Side Effects and Prognosis in Non-small Cell Lung Cancer Patients Receiving Erlotinib
Nazım Can DEMİRCAN1,Ceren Özge ENGÜR2,Tuğba AKIN TELLİ1,Tuğba BAŞOĞLU1,Rukiye ARIKAN1,Alper YAŞAR1,Abdussamet ÇELEBİ1,Özkan ALAN1,Selver IŞIK1,Salih ÖZGÜVEN2,Özlem ERCELEP1,Faysal DANE1,Handan KAYA3,Tunç ÖNEŞ2,Perran Fulden YUMUK1
1Division of Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul-Türkiye
2Department of Nuclear Medicine, Marmara University Faculty of Medicine, İstanbul-Türkiye
3Department of Pathology, Marmara University Faculty of Medicine, İstanbul-Türkiye
DOI : 10.5505/tjo.2022.3547 OBJECTIVE
We investigated the relationship of baseline sarcopenia with toxicities, treatment response, and survival in patients who had non-small cell lung cancer (NSCLC) harboring an epidermal growth factor receptor (EGFR) mutation and received erlotinib.

Computed tomography images from PET/CT scans before erlotinib treatment were retrospectively assessed. Skeletal muscle index, calculated as skeletal muscle area at third lumbar vertebra level/square of height, was used to define sarcopenia with <52.4 cm2/m2 for males and <38.5 cm2/m2 for females. Cox hazard models were conducted to determine predictors of survival.

The study included 30 patients, and 11 (36.7%) were sarcopenic. All-grade and Grade 3 toxicities were more frequent in sarcopenic group, although it was statistically insignificant (81.8% vs. 63.2%, p=0.282 for all-grade, and 18.2% vs. 10.5%, p=0.552 for grade 3). Response rates were 63.6% in sarcopenic and 68.4% in non-sarcopenic patients (p=0.789). Median progression-free survival was 7.9 and 9.2 months in sarcopenic and non-sarcopenic cases, respectively (p=0.561). However, median overall survival (OS) of sarcopenic patients was significantly shorter than non-sarcopenic ones (11.8 vs. 30.2 months, p=0.023), and sarcopenia predicted OS independently in multivariate analysis (Hazard ratio=2.63, p=0.029).

Early recognition, treatment, and prevention of sarcopenia may improve long-term survival in EGFRmutant NSCLC patients treated with first-line erlotinib. Keywords : Epidermal growth factor receptor; erlotinib; non-small cell lung cancer; prognosis; sarcopenia