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R.D. Hall
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-040 - Prospective Evaluation of Changes in Cancer Cachexia in NSCLC in Patients given Chemotherapy by Correlating Skeletal Muscle Mass with PRO Results (ID 2845)
09:30 - 09:30 | Author(s): R.D. Hall
- Abstract
Background:
Cancer cachexia and sarcopenia are common in lung cancer, and are associated with poor outcomes. Several recent interventional trials in cancer cachexia in patients with lung cancer have endeavored to improve skeletal muscle mass (measured by skeletal muscle mass index – SMI - using DXA or CT) and to correlate changes with functional outcomes of benefit to the patient. While functional tests such as stair climb power and hand grip strength have been used, these measures are neither sufficiently sensitive in patients with cancer, nor do they evaluate outcomes demonstrated to be valuable to patients. Patient Reported Outcomes (PROs) such as EORTC, FACT and others, have been collected, but specific components useful to patients have not been identified as ones correlating highly with SMI. Recent large studies at baseline using the 3-Item Global Index (3IGI) of the Lung Cancer Symptoms Scale (LCSS) quality of life and functional measure found strong correlations predicting survival in non-small cell lung cancer (N = 602) and in mesothelioma (N = 444); thus the 3IGI appears to be a good factor for associating PROs with SMI changes (Symanowski ASCO 2014; Gralla ASCO 2014). Additionally, over 90% of patients with NSCLC have expressed that parameters such as activity level and quality of life (included in the 3IGI) are of great importance to them.
Methods:
The LCSS was measured every 3 weeks in patients with a minimum KPS = 60 who were receiving chemotherapy. Correlations of SMI changes with 3IGI scores were made at baseline (at the time of initiation of chemotherapy) and at a median of 14 weeks in patients with Stage IIIB or IV NSCLC. SMI was measured by CT (Slice-O-Matic software) at the L1 vertebral level. A change in SMI by ± 4% was considered a threshold change of importance.
Results:
We have analyzed 24 patients to date (50% female; medians: age 57, KPS 80%; baseline: BMI 24.3, SMI 59.9, with 38% of males < 55.4 SMI). 19 patients are evaluable at this time. 42% of patients had a change in SMI by ± 4%; of these 75% had either improvement or worsening of the 3IGI in the direction expected from the change in SMI (improved 3IGI with increased SMI; worsened 3IGI with decreased SMI). No clear relationship in SMI was observed with response to chemotherapy thus far in the analysis.
Conclusion:
These results suggest: 1) the 3IGI may be useful in identifying both positive and negative changes in SMI, when using a 4% threshold change; 2) while we continue to enlist patients in this study, a confirmatory larger evaluation should be conducted; and 3) no measure should be used in practice or clinical trials of cancer cachexia or sarcopenia unless it has demonstrated validity in patients with cancer.
