Better Muscle Mass Linked to Improved Immunotherapy Response

Anatomical model of human muscle

Researchers at Osaka University in Japan have identified a key component of physical health associated with response to immunotherapy drugs.

Among people with non-small cell lung cancer, higher levels of muscle mass predicted a better response to PD-1 inhibitor immunotherapy.

Sarcopenia — the term used to describe low muscle mass levels — appears to reduce the benefits a person receives from immunotherapy cancer treatment.

“Sarcopenia at baseline is a significant predictor of worse outcome in patients with advanced NSCLC [non-small cell lung cancer] receiving PD-1 blockade,” the study investigators wrote.

The results, published February 21 in Nature Scientific Reports, highlight the importance of good baseline strength and physical function for mesothelioma patients considering immunotherapy treatments.

Immunotherapy is not a standard mesothelioma treatment option. However, there are more than a dozen clinical trials currently investigating PD-1 inhibitor therapy for the asbestos-related cancer.

“Screening for sarcopenia may help identify patients more likely to achieve a long-term response in routine clinical practice,” the authors wrote.

Strong Body, Stronger Immunotherapy Response Rate

Researchers collected information on 42 men and women with non-small cell lung cancer seen at their facility between January 2016 and September 2018.

The patients were treated with Opdivo (nivolumab) or Keytruda (pembrolizumab).

CT scans available in the medical records allowed the investigators to estimate each patient’s muscle mass.

If muscle mass fell below a predetermined cut point, they were classified as having sarcopenia.

Slightly more than half of patients had sarcopenia. These subjects had significantly worse outcomes.

NSCLC One-Year, Progression-Free Survival Rate

  • No Sarcopenia: 38.1 percent
  • Sarcopenia: 10.1 percent

NSCLC Overall Response Rate

  • No Sarcopenia: 40.0 percent
  • Sarcopenia: 9.1 percent

Low Muscle Mass Known to Impact Cancer Treatment

Dozens of studies have documented the connection between low muscle mass and poor outcomes in cancer patients.

In nearly every type of solid tumor studied, researchers have demonstrated patients with sarcopenia fare worse during and after cancer treatments.

This holds true for surgery, radiation therapy and chemotherapy.

Having low muscle mass is associated with more infections, more treatment-related toxicities and shorter progression-free and overall survival.

The results of the Osaka University study show reduced response to immunotherapy can be added to the list.

Immunotherapy and Mesothelioma

As investigators continue to study how best to use immunotherapy to treat mesothelioma, it is likely more patients will have the opportunity to try these drugs.

Regardless of what treatment is planned, studies support prioritizing a balanced diet with plenty of protein as well as gentle movement to keep the body functioning efficiently.

Nutrition experts consistently identify these as important components of cancer care for all patients starting treatment, regardless of tumor type.

“Early recognition and treatment of sarcopenia have the potential to bring additional benefits to all patients scheduled to receive immune checkpoint inhibitors,” the authors wrote. “We believe that the prevention of skeletal muscle loss and the development of predictive biomarkers are both important to gaining the greatest benefit from immune checkpoint inhibitors in the future.”

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Oncology Medical Writer

Suzanne Dixon is a registered dietitian, epidemiologist and experienced medical writer. She has volunteered with the National Cancer Policy Forum, Oncology Nutrition Dietetic Practice Group, American Institute for Cancer Research, American Society for Clinical Oncology, The National Academies of Sciences, Engineering, and Medicine. The New York Times and Time Magazine also have reviewed her cancer patient resources.

8 Cited Article Sources

The sources on all content featured in The Mesothelioma Center at include medical and scientific studies, peer-reviewed studies and other research documents from reputable organizations.

  1. Shiroyama, T. et al. (2019, February 21). Impact of sarcopenia in patients with advanced non–small cell lung cancer treated with PD-1 inhibitors: A preliminary retrospective study.
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  2. Deng, H.Y. et al. (2019, March 6). Does sarcopenia have any impact on survival of patients with surgically treated non-small-cell lung cancer?
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  3. Kudou, K. et al. (2018, July 10). Postoperative development of sarcopenia is a strong predictor of a poor prognosis in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer.
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  4. Sun, G. et al. (2018, October). Can sarcopenia be a predictor of prognosis for patients with non-metastatic colorectal cancer? A systematic review and meta-analysis.
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  5. Ataseven, B. et al. (2018, October). Skeletal Muscle Attenuation (Sarcopenia) Predicts Reduced Overall Survival in Patients with Advanced Epithelial Ovarian Cancer Undergoing Primary Debulking Surgery.
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  6. Brown, J.C. et al. (2019, January 13). The evolution of body composition in oncology-epidemiology, clinical trials, and the future of patient care: facts and numbers.
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  8. Santilli, V. et al. (2014, December 10). Clinical definition of sarcopenia. Retrieved from:

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