The Effect of Malnutrition on Treatment Efficacy and Toxicity in Geriatric Patients Treated With Immune Checkpoint...

Immune checkpoint inhibitors (ICIs) have been shown to be effective in various cancer subtypes and their use in clinical practice has become widespread in recent years. However, discussions on their effectiveness in geriatric patients and in cases of malnutrition are still ongoing. The aim of the study was to evaluate the association of geriatric nutritional index (GNRI) detected malnutrition risk with progression-free survival (PFS) and immune related adverse events (irAEs) in geriatric solid tumor patients treated with ICIs.

The study was conducted retrospectively and included patients with metastatic solid tumors who received second- or third-line immunotherapy between 2018 and 2024 at the Dr. Abdurrahman Yurtaslan, Ankara Oncology Education and Research Hospital and Etlik City Hospital. The GNRI score of the patients at the start of immunotherapy was calculated, and the relationship between the GNRI score and PFS and irAEs was evaluated.

No significant association was found between sex (p=0.28), comorbidity (p=0.34), polypharmacy (p=0.09), antibiotic (p=0.24) use and PFS. A significant association was found between ECOG PS (p<0.05) and GNRI (p=0.012) and PFS. In multivariate analysis, ECOG PS [hazard ratio (HR)=1.5, 95% confidence interval (CI)=1.0-2.2, p=0.036] and GNRI (HR=0.6, 95% CI=0.4-0.9, p=0.033) were statistically significant. The incidence of irAEs was statistically higher in patients with GNRI <98 (p=0.019).

Geriatric solid tumor patients are not fully represented in prospective clinical drug trials. Prospective studies are needed in which only geriatric patients are included, treatment efficacy and toxicity are assessed stepwise according to nutritional status, and malnutrition is treated to increase treatment efficacy and reduce toxicity.