Nutritional status and drug resistance in EGFR-mutant NSCLC: a retrospective cohort study on almonertinib efficacy

To evaluate the clinical efficacy and safety of Almonertinib in EGFR-mutant advanced NSCLC patients with different nutritional statuses. Clinical data from 56 patients with advanced EGFR-mutant NSCLC admitted to the First Affiliated Hospital of Anhui Medical University from April 2021 to April 2023 were retrospectively analyzed. Patients were stratified into two groups based on nutritional risk (nutritional risk group, n = 30; non-risk group, n = 26) and into two groups based on malnutrition status (malnutrition group, n = 35; regular nutrition group, n = 21). Kaplan-Meier methods were used to plot survival curves, the Chi-square test was employed to evaluate clinical efficacy, and Cox regression analysis was applied to identify factors associated with adverse reactions. Patients in the nutritional risk group had a median progression-free survival (mPFS) of 12.8 months (95% CI: 9.146-16.454), which was shorter than that of the non-risk group (mPFS: 19.7 months; 95% CI: 12.234-27.166), showing statistical significance (P = 0.049). However, there was no significant difference in median overall survival (mOS) between the two groups (P = 0.546). In the malnutrition group, patients had an mPFS of 12.6 months (95% CI: 9.648-15.552) and an mOS of 29.8 months (95% CI: 24.476-35.124), both significantly shorter than those of the regular nutrition group (mPFS: 19.7 months, 95% CI: 13.097-26.303; mOS: 32.1 months, 95% CI: 23.781-40.419) (P = 0.034 and P = 0.046, respectively). There was no significant difference in objective response rate (ORR) between groups (P > 0.05). Serum albumin levels were independently associated with the incidence of adverse reactions (P = 0.003; HR: 7.194, 95% CI: 1.925-26.886). Almonertinib demonstrates favorable efficacy and safety in treating advanced NSCLC patients with malnutrition or nutritional risk accompanying EGFR mutations. The shortened PFS observed in cachectic patients may reflect accelerated disease progression related to poor nutritional status rather than Almonertinib-specific resistance. Moreover, mild to moderate anxiety was observed in all patients receiving Almonertinib, underscoring the importance of incorporating psychological support in cancer care.