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Association Between Immunotherapy and Overall Survival in Malnourished Patients with Advanced Non-Small Cell Lung

Maya Shimasaki¹, Yasutaka Ihara^2,3,4, Shoichiro Yamamoto^5,6

¹Department of Clinical Pharmacy, College of Pharmaceutical Sciences, Matsuyama University, Matsuyama, Japan.

Nutrition and Cancer

|October 11, 2025

Abstract

Background:

Malnutrition is common among patients with advanced non-small cell lung cancer (NSCLC) and may diminish the survival benefits of immunotherapy. We aimed to evaluate the association between nutritional status-assessed using the Geriatric Nutritional Risk Index (GNRI) at initiation of first-line therapy and overall survival in patients with advanced NSCLC receiving immunotherapy.

Methods:

We conducted a retrospective cohort study using an administrative claims database. Patients aged ≥18 years who received first-line immunotherapy for newly diagnosed advanced NSCLC between December 2016 and December 2024 were included. GNRI was calculated using the laboratory and anthropometric data closest (within 3 months) to treatment initiation. To examine whether the GNRI modifies the association between immunotherapy as a first-line therapy and overall survival in patients with advanced NSCLC, we used nonlinear multivariable Cox proportional hazards regressions.

Results:

Among 2461 patients (mean (SD) age: 70.85 (8.97) years; 81% males), the mean (SD) GNRI was 93.20 (12.93). Using GNRI 100 as the reference, lower GNRI values conferred progressively higher risks of death.

Conclusion:

Routine nutritional screening using GNRI and proactive interventions to maintain a GNRI ≥ 100, may improve overall survival in patients with advanced NSCLC receiving immunotherapy.

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