Abstract: FR-PO244
AKI and Anemia Are Common in Patients with Sarcopenia and CKD Receiving Carboplatin, Pemetrexed, and Pembrolizumab for Advanced Non-Small-Cell Lung Cancer
Session Information
- Onconephrology: From AKI to CKD and Everything in Between
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Katz, Nurit S., Mass General Brigham Inc, Boston, Massachusetts, United States
- Mantz, Lea, Mass General Brigham Inc, Boston, Massachusetts, United States
- Hanna, Paul, Mass General Brigham Inc, Boston, Massachusetts, United States
- Ouyang, Tianqi, Mass General Brigham Inc, Boston, Massachusetts, United States
- Fintelmann, Florian J., Mass General Brigham Inc, Boston, Massachusetts, United States
- Sise, Meghan E., Mass General Brigham Inc, Boston, Massachusetts, United States
Background
Carboplatin, pemetrexed, and pembrolizumab (triplet therapy), which are first line treatment in advanced non-small cell lung cancer (aNSCLC) may cause acute kidney injury (AKI) and cytopenias. Carboplatin and pemetrexed are renally cleared and require dose adjustments in patients with reduced estimated glomerular filtration rate (eGFR), which may be overestimated in patients with sarcopenia. We hypothesized that patients with sarcopenia treated with triplet therapy have increased risk for AEs.
Methods
In this retrospective cohort study for adults with aNSCLC who received triplet therapy (2016-2022), we performed body composition analysis of T10 or L3 vertebral level on routine CT scan obtained within 90 days of treatment using a validated deep learning pipeline. Sarcopenia was defined using sex-specific cutoffs for skeletal muscle index (SMI). AEs included AKI, anemia , thrombocytopenia or neutropenia. We fit multivariable logistic regression to determine the association between sarcopenia and each AE, adjusting confounders. We assessed the rates of AE in patients with sarcopenia and without sarcopenia with or without CKD.
Results
595 patients were included, mean age 65.9 ± 9.7, 51.4% female. 28.6% met CT-criteria for sarcopenia. 66.9% had one or more AEs. Patients with sarcopenia had increased odds of AKI and anemia (Figure 1), adjusted for confounders.Patients with concomitant sarcopenia and CKD had the highest rates of AEs (Figure 2).
Conclusion
Patients with aNSCLC and sarcopenia are at increased risk for AEs from triplet therapy, possibly due to eGFR overestimation and failure to appropriately dose-reduce chemotherapy.