Biochemical Marker Is a Better Predictor of Adverse Effects in Patients with Non-small Cell Lung Cancer
Albumin concentration with an established cutoff point is proven a better predictor of both chemotherapy toxicity and survival in patients with advanced lung cancer, a study published in Supportive Care in Cancer has shown.1
Patients with advanced cancer frequently experience cancer cachexia and sarcopenia, which are associated with poor survival. Predictors of benefit of chemotherapy or factors that predict survival in these patients, however, are not known. Therefore, these researchers sought to determine the prevalence of these adverse effects, and their relation to chemotoxicity and survival prediction in patients with advanced non-small cell lung cancer (NSCLC) stage IIIB or IV based on international consensus definition and criteria for diagnosis.
Secondary goal of the study was a comparison of the biochemical markers CRP, albumin, protein, IL-6, and hemoglobin with time to tumor progression to assess prognostic value or guide treatment.
For the study, researchers recruited 100 patients with advanced lung cancer; 67 participants were male, median age was 64 years. Anthropometric measurements and biochemical data (CRP, albumin, protein, IL-6, hemoglobin) along with body composition measurements (total muscle cross-sectional area, lumbar skeletal muscle index) were obtained for each patient before initiating platinum-doublet therapy. Computerized tomography was used to measure skeletal muscle cross-sectional area at the third lumbar vertebra, and a previously published cutoff point was used to define sarcopenia. Chemotherapy toxicity was assessed after cycle 1 of treatment, with time-to-tumor progression prospectively determined.
Results showed median time to disease progression was 187 days. Prevalence of cachexia and sarcopenia in study group was 69% and 47%, respectively. Statistically significant difference was seen in CRP, IL-6, and albumin concentration in patients with cancer cachexia compared with noncachectic patients (P = .020, P = .040, P = .003, respectively).
Based on these findings, cachexia and sarcopenia and time to tumor progression were not predictive of chemotoxicity. However, albumin concentration with an established cutoff point of 37.5 g/L was predictive of both chemotoxicity (OR [95% CI] = 0.85; P < .001) and survival (HR [95 % CI] = .55).
“Albumin level has been shown to be more important predictive marker of chemotherapy toxicity and survival than cachexia and sarcopenia are,” the researchers conclude. This approach can be used to guide treatment choice in clinical settings.
1. Srdic D, Plestina S, Sverko-Peternac A, Nikolac N, Simundic AM, Samarzija M. Cancer cachexia, sarcopenia and biochemical markers in patients with advanced non-small cell lung cancer—chemotherapy toxicity and prognostic value [published online May 28, 2016]. Support Care Cancer. doi:10.1007/s00520-016-3287-y.