Association between metabolic status and nivolumab efficacy in metastatic non-small cell lung cancer: Focus on resting energy expenditure

Abstract

Objective: Non-small cell lung cancer (NSCLC) is a common and deadly cancer, and predicting survival can be useful for guiding treatment. This study aimed to investigate the impact of metabolic status—specifically resting energy expenditure (REE)—and clinicopathological characteristics on survival outcomes in patients with metastatic NSCLC receiving nivolumab as second-line therapy following platinum-based chemotherapy. Methods: This prospective, non-interventional, observational, single-center study included 148 adult patients with metastatic NSCLC receiving nivolumab as second-line treatment. Demographic data, cancer diagnosis-related characteristics, laboratory parameters, measured REE (mREE), and predicted REE (pREE) were recorded just before nivolumab treatment was initiated. Results: The mean ages of non-hypermetabolic and hypermetabolic patients were 63 ± 8 and 64 ± 9, respectively. Weight, height, BMI, and pREE were significantly higher in the non-hypermetabolic group. In the hypermetabolic group, the incidence of brain metastasis and the mREE were significantly higher. The median progression-free survival (PFS) and overall survival (OS) were 5.3 and 15.8 months, respectively. Multivariate analysis identified several predictors of survival. Poor ECOG performance status (PS) (p < 0.001), liver metastases (p = 0.018), and mREE/pREE ratio > 120% (p = 0.005) were significantly associated with shorter PFS. Similarly, poor ECOG PS (p = 0.037), liver metastases (p = 0.041), and mREE/pREE ratio > 120% (p = 0.009) were also linked to reduced OS. Conclusions: In patients with NSCLC treated with nivolumab, poor ECOG PS, the presence of liver metastases, and an mREE/pREE ratio > 120% were associated with poorer survival outcomes. Further prospective multicenter studies are required to validate these findings.