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Sarcopenia and the risk of adverse events in patients treated with immune checkpoint inhibitors: a systematic review

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Abstract

Background

Sarcopenia has been associated with negative clinical outcomes in cancer patients, particularly response to treatment and survival. The exponential growth in the use of immune checkpoint inhibitors (ICIs) has led to an increase in the reporting of both adverse events in general (AEs) and immune-related adverse events (irAEs), which are unintended immune-related phenomenon that take place as a result of checkpoint blockade. However, there are no systematic reviews evaluating the relationship between sarcopenia and the risk of developing AEs and irAEs in cancer patients on ICI therapies.

Methods

PubMed, MEDLINE, Embase, Cochrane and grey literature, repositories, websites Open Grey, Google Scholar, and abstracts of major international congresses were searched up to April 2020 for observational studies on sarcopenia and both AEs and irAEs in patients treated with ICIs. Study quality was assessed with The Newcastle–Ottawa quality assessment scale. PROSPERO registration number: CRD42020197178.

Results

One hundred and thirteen discrete articles were identified. Seven studies were included after evaluation of the eligibility criteria. Important sources of heterogeneity including the specific cut-points defining sarcopenia, sample size, inclusion and exclusion criteria, treatment regimen, and baseline demographics were evaluated and accounted for accordingly.

Conclusion

Most of the included studies showed an increased risk of AEs with use of ICIs in cancer patients with sarcopenia, and in the majority of these, the increase was statistically significant. Due to the small number of available studies and the expanding use of ICIs, additional research is warranted.

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Authors and Affiliations

  1. International Centre for Medical Research, Dorset, UK

    Yuli Guzman-Prado

  2. Department of Medicine, E. Wolfson Medical Center, Holon, Israel

    Jennifer Ben Shimol

  3. Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel

    Jennifer Ben Shimol

  4. Alltrista, Christchurch, Dorset, UK

    Ondrej Samson

Authors
  1. Yuli Guzman-Prado
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  2. Jennifer Ben Shimol
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  3. Ondrej Samson
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, analysis and validation were performed by Yuli Guzman-Prado, Jennifer Ben Shimol and Ondrej Samson. The first draft of the manuscript was written by Yuli Guzman-Prado and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yuli Guzman-Prado.

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Yuli Guzman-Prado declares that she has no conflict of interest. Jennifer Ben Shimol declares that she has no conflict of interest. Ondrej Samson declares that he has no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Guzman-Prado, Y., Ben Shimol, J. & Samson, O. Sarcopenia and the risk of adverse events in patients treated with immune checkpoint inhibitors: a systematic review. Cancer Immunol Immunother 70, 2771–2780 (2021). https://doi.org/10.1007/s00262-021-02888-6

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  • DOI: https://doi.org/10.1007/s00262-021-02888-6

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