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Research Paper|Volume 16, Issue 6|pp 5354—5369

Cancer cachexia reduces the efficacy of immune checkpoint inhibitors in cancer patients

Yean Yu1, Li Yan3, Tianhui Huang3, Zhenfu Wu4, Juan Liu2,5
  • 1Department of Nephrology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
  • 2Department of Critical Care Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
  • 3Department of Traditional Chinese Medicine, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
  • 4Department of Abdominal and Pelvic Medical Oncology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China
  • 5Department of Critical Care Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
* Equal contribution
Received: October 13, 2023Accepted: January 23, 2024Published: March 11, 2024
https://doi.org/10.18632/aging.205652

Copyright: © 2024 Yu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objective: Cachexia, a multifactorial syndrome, is frequently noticed in cancer patients. A recent study has shown inconsistent findings about the relationship between cachexia and the efficiency of immune checkpoint inhibitors (ICIs). To analyze this disparity, we did a meta-analysis.

Methods: From the beginning of each database to July 2023, literature describing the association between cachexia and prognosis of ICI-treated patients with solid malignancies was systematically searched in three online databases. Estimates were pooled, and 95% confidence intervals (CIs) were generated.

Results: We analyzed a total of 12 articles, which included data from 1407 patients. The combined results of our analysis showed that cancer patients with cachexia had significantly worse overall survival (HR = 1.88, 95% CI: 1.59–2.22, p < 0.001), progression-free survival (HR = 1.84, 95% CI: 1.59–2.12, p < 0.001), and time to treatment failure (HR = 2.15, 95% CI: 1.32–3.50, p = 0.002). These findings were consistent in both univariate and multivariate analyses. Additionally, while not statistically significant, we observed a trend towards a lower objective response rate in cancer patients with cachexia compared to those without cachexia (OR = 0.59, 95% CI: 0.32–1.09, p = 0.093).

Conclusion: Poor survival in cachexia patients suggests a negative relationship between cachexia and ICI efficacy. In clinical practice, the existence of cachexia should be estimated to choose individuals who may benefit from ICIs.