{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:42:35Z","timestamp":1790700155493,"version":"4.1.0"},"reference-count":73,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babes\u201d University of Medicine and Pharmacy, Timi\u0219oara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Immune checkpoint inhibitors targeting the PD-1\/PD-L1 axis have become a standard in the treatment of all stages of non-small lung cancer. Beyond tumor-intrinsic biomarkers like PD-L1 expression, evidence points to the role of patient-related factors, such as body mass index, sarcopenia, and cachexia. These body composition parameters may reflect metabolic reserve or even immune competence and could help stratify outcomes in patients treated with PD-1 and PD-L1. This systematic review aims to evaluate the impact of body composition\u2014specifically BMI, pretreatment weight loss, sarcopenia, and cachexia\u2014on clinical outcomes such as progression-free and overall survival in NSCLC patients treated with immune checkpoint inhibitors. Methods: A systematic literature search was conducted across multiple databases including PubMed, Google Scholar, and Science Direct. We included full-text original research articles (1 January 2020\u20131 May 2025) reporting clinical outcomes of NSCLC patients treated with PD-1 or PD-L1 inhibitors, in relation to body composition factors (BMI, pretreatment weight loss, sarcopenia, cachexia). Eligible studies involved adults (&gt;18 years) and included observational cohorts or controlled trials; animal or in vitro studies were excluded. Data extraction and risk of bias assessments were performed independently by two reviewers, with discrepancies being resolved through a third one. Results: From 12,358 records identified, 21 studies met the inclusion criteria. Most were retrospective cohorts assessing the impact of pre-treatment weight loss, cachexia, and sarcopenia on ICI outcomes in NSCLC. These factors consistently predicted poorer survival and response, while BMI alone showed limited prognostic value. Considerable heterogeneity in body composition definitions and outcome reporting was observed. Conclusions: Body composition\u2014particularly weight loss, cachexia, and sarcopenia\u2014significantly impacts survival and response in NSCLC patients treated with ICIs. These factors reflect immune\u2013metabolic dysfunction that may impair treatment efficacy. BMI alone is insufficient; routine assessment of muscle mass and cachexia could improve risk stratification.<\/jats:p>","DOI":"10.3390\/cancers17172765","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T06:26:14Z","timestamp":1756189574000},"page":"2765","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Impact of Body Composition on Outcomes in NSCLC Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1500-4402","authenticated-orcid":false,"given":"Carina","family":"Golban","sequence":"first","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Septimiu-Radu","family":"Susa","sequence":"additional","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0320-6904","authenticated-orcid":false,"given":"Norberth-Istvan","family":"Varga","sequence":"additional","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0512-9183","authenticated-orcid":false,"given":"Cristiana-Smaranda","family":"Ivan","sequence":"additional","affiliation":[{"name":"Department of General Medicine, \u201cVictor Babe\u015f\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia Ortansa","family":"Schirta","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolae C\u0103lin","family":"Schirta","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Medzentrum Pfungen Aerztehaus, Ried\u00e4ckerstrasse 5, 8422 Pfungen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9838-744X","authenticated-orcid":false,"given":"Alina Gabriela","family":"Negru","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1628-2359","authenticated-orcid":false,"given":"Sorin","family":"Saftescu","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine, \u201cVictor Babe\u015f\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serban Mircea","family":"Negru","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine, \u201cVictor Babe\u015f\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025, June 11). WHO Cancer Fact Sheet, Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cancer."},{"key":"ref_2","unstructured":"International Agency for Research on Cancer (2025, June 11). Global Cancer Observatory: Cancer Today. Lyon, France, Statistical Report, 2020. Available online: https:\/\/gco.iarc.fr\/today."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1186\/s12935-023-02990-y","article-title":"Recent advances in non-small cell lung cancer targeted therapy; an update review","volume":"23","author":"Araghi","year":"2023","journal-title":"Cancer Cell Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1186\/s12943-024-02156-y","article-title":"Regulatory T cells in immune checkpoint blockade antitumor therapy","volume":"23","author":"Zhang","year":"2024","journal-title":"Mol. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"217241","DOI":"10.1016\/j.canlet.2024.217241","article-title":"Immune checkpoint inhibitors rechallenge in non-small cell lung cancer: Current evidence and future directions","volume":"604","author":"Gang","year":"2024","journal-title":"Cancer Lett."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s12943-024-02023-w","article-title":"Regulatory mechanisms of PD-1\/PD-L1 in cancers","volume":"23","author":"Lin","year":"2024","journal-title":"Mol. Cancer"},{"key":"ref_7","first-page":"727","article-title":"PD-1\/PD-L1 pathway: Current researches in cancer","volume":"10","author":"Han","year":"2020","journal-title":"Am. J. Cancer Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s12943-018-0928-4","article-title":"Role of the tumor microenvironment in PD-L1\/PD-1-mediated tumor immune escape","volume":"18","author":"Jiang","year":"2019","journal-title":"Mol. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"9043","DOI":"10.1200\/JCO.2022.40.16_suppl.9043","article-title":"Three-year outcomes and correlative analyses in patients with non\u2013small cell lung cancer (NSCLC) and a very high PD-L1 tumor proportion score (TPS) \u2265 90% treated with first-line pembrolizumab","volume":"40","author":"Ricciuti","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.cllc.2024.05.002","article-title":"5-Year Real-World Outcomes with Frontline Pembrolizumab Monotherapy in PD-L1 Expression \u2265 50% Advanced NSCLC","volume":"25","author":"Velcheti","year":"2024","journal-title":"Clin. Lung Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Qin, H., Yan, H., Chen, Y., Xu, Q., Huang, Z., Jiang, W., Wang, Z., Deng, L., Zhang, X., and Zhang, L. (2024). Clinical outcomes for immune checkpoint inhibitors plus chemotherapy in non-small-cell lung cancer patients with uncommon driver gene alterations. BMC Cancer, 24.","DOI":"10.1186\/s12885-024-12748-y"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"114296","DOI":"10.1016\/j.ejca.2024.114296","article-title":"Five-year outcomes with first-line nivolumab plus ipilimumab with 2 cycles of chemotherapy versus 4 cycles of chemotherapy alone in patients with metastatic non-small cell lung cancer in the randomized CheckMate 9LA trial","volume":"211","author":"Reck","year":"2024","journal-title":"Eur. J. Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ma, W., Shi, Q., Zhang, L., Qiu, Z., Kuang, T., Zhao, K., and Wang, W. (2024). Impact of baseline body composition on prognostic outcomes in urological malignancies treated with immunotherapy: A pooled analysis of 10 retrospective studies. BMC Cancer, 24.","DOI":"10.1186\/s12885-024-12579-x"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kuang, T., Zhang, L., Qiu, Z., Zhang, Y., and Wang, W. (2023). Prognostic value of body composition on survival outcomes in melanoma patients receiving immunotherapy. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1261202"},{"key":"ref_15","first-page":"291.e27","article-title":"Impact of body composition on outcomes of immune checkpoint inhibitor combination therapy in patients with previously untreated advanced renal cell carcinoma","volume":"42","author":"Ishihara","year":"2024","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"da Fonseca, G.W.P., Farkas, J., Dora, E., von Haehling, S., and Lainscak, M. (2020). Cancer Cachexia and Related Metabolic Dysfunction. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21072321"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1111\/obr.12187","article-title":"Functional body composition and related aspects in research on obesity and cachexia: Report on the 12th Stock Conference held on 6 and 7 September 2013 in Hamburg, Germany","volume":"15","author":"Baracos","year":"2014","journal-title":"Obes. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.clnesp.2025.01.052","article-title":"Relationship between muscular mass, inflammatory status, tumor metabolic activity and oral intake in head and neck cancer at the outset of management","volume":"66","author":"Rey","year":"2025","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1111\/1759-7714.13598","article-title":"Identifying sarcopenia in advanced non-small cell lung cancer patients using skeletal muscle CT radiomics and machine learning","volume":"11","author":"Dong","year":"2020","journal-title":"Thorac. Cancer"},{"key":"ref_20","first-page":"7","article-title":"The prevalence of sarcopenia amongst non-small cell lung cancer patients, assessed using computed tomography, prior to treatment in a South African setting","volume":"6","author":"Solomon","year":"2022","journal-title":"S. Afr. J. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Hakozaki, T., Nolin-Lapalme, A., Kogawa, M., Okuma, Y., Nakamura, S., Moreau-Amaru, D., Tamura, T., Hosomi, Y., Takeyama, H., and Richard, C. (2022). Cancer Cachexia among Patients with Advanced Non-Small-Cell Lung Cancer on Immunotherapy: An Observational Study with Exploratory Gut Microbiota Analysis. Cancers, 14.","DOI":"10.3390\/cancers14215405"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1080\/0284186X.2023.2180660","article-title":"Sarcopenia and loss of muscle mass in patients with lung cancer undergoing chemotherapy treatment: A systematic review and meta-analysis","volume":"62","author":"Jensen","year":"2023","journal-title":"Acta Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Katsui, K., Ogata, T., Sugiyama, S., Yoshio, K., Kuroda, M., Hiraki, T., Kiura, K., Maeda, Y., Toyooka, S., and Kanazawa, S. (2021). Sarcopenia is associated with poor prognosis after chemoradiotherapy in patients with stage III non-small-cell lung cancer: A retrospective analysis. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-91449-z"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.pccm.2024.02.003","article-title":"Understanding cachexia and its impact on lung cancer and beyond","volume":"2","author":"Yue","year":"2024","journal-title":"Chin. Med J. - Pulm. Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zhang, T., Li, S., Chang, J., Qin, Y., and Li, C. (2023). Impact of BMI on the survival outcomes of non-small cell lung cancer patients treated with immune checkpoint inhibitors: A meta-analysis. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-11512-y"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Assump\u00e7\u00e3o, J.A.F., Pasquarelli-Do-Nascimento, G., Duarte, M.S.V., Bonamino, M.H., and Magalh\u00e3es, K.G. (2022). The ambiguous role of obesity in oncology by promoting cancer but boosting antitumor immunotherapy. J. Biomed. Sci., 29.","DOI":"10.1186\/s12929-022-00796-0"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e001403","DOI":"10.1136\/jitc-2020-001403","article-title":"Baseline BMI and BMI variation during first line pembrolizumab in NSCLC patients with a PD-L1 expression \u2265 50%: A multicenter study with external validation","volume":"8","author":"Cortellini","year":"2020","journal-title":"J. Immunother. Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"106907","DOI":"10.1016\/j.intimp.2020.106907","article-title":"Sarcopenia affects clinical efficacy of immune checkpoint inhibitors in non-small cell lung cancer patients: A systematic review and meta-analysis","volume":"88","author":"Wang","year":"2020","journal-title":"Int. Immunopharmacol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.lungcan.2020.03.003","article-title":"Cachexia-sarcopenia as a determinant of disease control rate and survival in non-small lung cancer patients receiving immune-checkpoint inhibitors","volume":"143","author":"Roch","year":"2020","journal-title":"Lung Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"7379","DOI":"10.3390\/curroncol31110544","article-title":"Sex-Related Differences in Immunotherapy Outcomes of Patients with Advanced Non-Small Cell Lung Cancer","volume":"31","author":"Cohen","year":"2024","journal-title":"Curr. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S1470-2045(18)30078-0","article-title":"Association of body-mass index and outcomes in patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy: A retrospective, multicohort analysis","volume":"19","author":"McQuade","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1038\/s44324-024-00007-4","article-title":"Potential roles of sex-linked differences in obesity and cancer immunotherapy: Revisiting the obesity paradox","volume":"2","author":"Vick","year":"2024","journal-title":"npj Metab. Health Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Ishida, Y., Maeda, K., Yamanaka, Y., Matsuyama, R., Kato, R., Yamaguchi, M., Nonogaki, T., Shimizu, A., Ueshima, J., and Murotani, K. (2020). Formula for the Cross-Sectional Area of the Muscles of the Third Lumbar Vertebra Level from the Twelfth Thoracic Vertebra Level Slice on Computed Tomography. Geriatrics, 5.","DOI":"10.3390\/geriatrics5030047"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and classification of cancer cachexia: An international consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Tenuta, M., Gelibter, A., Pandozzi, C., Sirgiovanni, G., Campolo, F., Venneri, M.A., Caponnetto, S., Cortesi, E., Marchetti, P., and Isidori, A.M. (2021). Impact of Sarcopenia and Inflammation on Patients with Advanced Non-Small Cell Lung Cancer (NCSCL) Treated with Immune Checkpoint Inhibitors (ICIs): A Prospective Study. Cancers, 13.","DOI":"10.3390\/cancers13246355"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1001\/jamaoncol.2024.1120","article-title":"Body Composition in Advanced Non-Small Cell Lung Cancer Treated with Immunotherapy","volume":"10","author":"Chaunzwa","year":"2024","journal-title":"JAMA Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"9","DOI":"10.14740\/wjon1225","article-title":"Sarcopenia and Visceral Adiposity Did Not Affect Efficacy of Immune-Checkpoint Inhibitor Monotherapy for Pretreated Patients with Advanced Non-Small Cell Lung Cancer","volume":"11","author":"Minami","year":"2020","journal-title":"World J. Oncol."},{"key":"ref_39","first-page":"100020","article-title":"Desensitizing Effect of Cancer Cachexia on Immune Checkpoint Inhibitors in Patients with Advanced NSCLC","volume":"1","author":"Miyawaki","year":"2020","journal-title":"JTO Clin. Res. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1002\/cam4.3631","article-title":"Unfavorable impact of decreased muscle quality on the efficacy of immunotherapy for advanced non-small cell lung cancer","volume":"10","author":"Nishioka","year":"2021","journal-title":"Cancer Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1007\/s00432-020-03146-5","article-title":"Clinical impact of skeletal muscle area in patients with non-small cell lung cancer treated with anti-PD-1 inhibitors","volume":"146","author":"Takada","year":"2021","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.21037\/atm-21-6578","article-title":"Assessment of sarcopenia as a predictor of poor overall survival for advanced non-small-cell lung cancer patients receiving salvage anti-PD-1 immunotherapy","volume":"9","author":"Wang","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_43","first-page":"1633","article-title":"Impact of weight loss on treatment with PD-1\/PD-L1 inhibitors plus chemotherapy in advanced non-small-cell lung cancer","volume":"30","author":"Miyawaki","year":"2022","journal-title":"Support. Care Cancer"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Liu, Z., Diao, Y., and Li, X. (2022). Body mass index and serum markers associated with progression-free survival in lung cancer patients treated with immune checkpoint inhibitors. BMC Cancer, 22.","DOI":"10.1186\/s12885-022-09744-5"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Jin, J., Visina, J., Burns, T.F., Diergaarde, B., and Stabile, L.P. (2023). Male sex and pretreatment weight loss are associated with poor outcome in patients with advanced non-small cell lung cancer treated with immunotherapy: A retrospective study. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-43866-5"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2898","DOI":"10.1002\/jcsm.13367","article-title":"Obesity paradox in patients with non-small cell lung cancer undergoing immune checkpoint inhibitor therapy","volume":"14","author":"Lee","year":"2023","journal-title":"J. Cachex- Sarcopenia Muscle"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1111\/1759-7714.14881","article-title":"Prognostic effect of cachexia in patients with non-small cell lung cancer receiving immune checkpoint inhibitors","volume":"14","author":"Matsuo","year":"2023","journal-title":"Thorac. Cancer"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"19471","DOI":"10.1002\/cam4.6549","article-title":"Survival and biomarkers for cachexia in non-small cell lung cancer receiving immune checkpoint inhibitors","volume":"12","author":"Murata","year":"2023","journal-title":"Cancer Med."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Tanimura, K., Takeda, T., Yoshimura, A., Honda, R., Goda, S., Shiotsu, S., Fukui, M., Chihara, Y., Uryu, K., and Takei, S. (2023). Predictive Value of Modified Glasgow Prognostic Score and Persistent Inflammation among Patients with Non-Small Cell Lung Cancer Treated with Durvalumab Consolidation after Chemoradiotherapy: A Multicenter Retrospective Study. Cancers, 15.","DOI":"10.3390\/cancers15174358"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2442116","DOI":"10.1080\/2162402X.2024.2442116","article-title":"Clinical impact of cancer cachexia on the outcome of patients with non-small cell lung cancer with PD-L1 tumor proportion scores of \u226550% receiving pembrolizumab monotherapy versus immune checkpoint inhibitor with chemotherapy","volume":"14","author":"Kawachi","year":"2025","journal-title":"OncoImmunology"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Xue, D., Li, N., Yang, J., Men, K., Li, L., Jiang, H., Zhao, X., Zhang, S., and Chen, X. (2024). Sarcopenia predicts immune-related adverse events due to anti-PD-1\/PD-L1 therapy in patients with advanced lung cancer. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1450020"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Kuno, H., Nishioka, N., Yamada, T., Kunimatsu, Y., Yoshimura, A., Hirai, S., Futamura, S., Masui, T., Egami, M., and Chihara, Y. (2024). The Significance of Longitudinal Psoas Muscle Loss in Predicting the Maintenance Efficacy of Durvalumab Treatment Following Concurrent Chemoradiotherapy in Patients with Non-Small Cell Lung Cancer: A Retrospective Study. Cancers, 16.","DOI":"10.3390\/cancers16173037"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3538","DOI":"10.21037\/tlcr-21-460","article-title":"Cancer cachexia syndrome and clinical outcome in patients with metastatic non-small cell lung cancer treated with PD-1\/PD-L1 inhibitors: Results from a prospective, observational study","volume":"10","author":"Rounis","year":"2021","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ejca.2022.10.013","article-title":"Protective effect of obesity on survival in cancers treated with immunotherapy vanishes when controlling for type of cancer, weight loss and reduced skeletal muscle","volume":"178","author":"Antoun","year":"2023","journal-title":"Eur. J. Cancer"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Madeddu, C., Busquets, S., Donisi, C., Lai, E., Pretta, A., L\u00f3pez-Soriano, F.J., Argil\u00e9s, J.M., Scartozzi, M., and Macci\u00f2, A. (2023). Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung Cancer. Cancers, 15.","DOI":"10.3390\/cancers15041076"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1038\/s41584-021-00584-4","article-title":"TNF in the era of immune checkpoint inhibitors: Friend or foe?","volume":"17","author":"Chen","year":"2021","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"100878","DOI":"10.1016\/j.xcrm.2022.100878","article-title":"CD8+ T cell-intrinsic IL-6 signaling promotes resistance to anti-PD-L1 immunotherapy","volume":"4","author":"Huseni","year":"2023","journal-title":"Cell Rep. Med."},{"key":"ref_58","first-page":"7960","article-title":"Therapeutic strategies against cancer cachexia","volume":"29","author":"Stemmler","year":"2019","journal-title":"Eur. J. Transl. Myol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Ma, S., Zhao, G., Sui, S., Chen, X., Wu, L., Wang, T., Xu, W., Lu, Z., Wang, A., and Wu, X. (2025). Tumor microenvironment and immune-related myositis: Addressing muscle wasting in cancer immunotherapy. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1580108"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"VanderVeen, B.N., Murphy, E.A., and Carson, J.A. (2020). The Impact of Immune Cells on the Skeletal Muscle Microenvironment During Cancer Cachexia. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.01037"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1016\/j.cell.2023.03.028","article-title":"Cachexia: A systemic consequence of progressive, unresolved disease","volume":"186","author":"Ferrer","year":"2023","journal-title":"Cell"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1002\/jcsm.12206","article-title":"Muscle mass and association to quality of life in non-small cell lung cancer patients","volume":"8","author":"Bye","year":"2017","journal-title":"J. Cachex-Sarcopenia Muscle"},{"key":"ref_63","first-page":"e00065","article-title":"The Role of Systemic Inflammation in Cancer-Associated Muscle Wasting and Rationale for Exercise as a Therapeutic Intervention","volume":"3","author":"Cole","year":"2018","journal-title":"JCSM Clin. Rep."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.jtho.2018.04.035","article-title":"Sarcopenia in Resected NSCLC: Effect on Postoperative Outcomes","volume":"13","author":"Nakamura","year":"2018","journal-title":"J. Thorac. Oncol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s12979-024-00458-9","article-title":"Harnessing immunomodulation to combat sarcopenia: Current insights and possible approaches","volume":"21","author":"Zhang","year":"2024","journal-title":"Immun. Ageing"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Zanetti, M., Cappellari, G.G., Barazzoni, R., and Sanson, G. (2020). The Impact of Protein Supplementation Targeted at Improving Muscle Mass on Strength in Cancer Patients: A Scoping Review. Nutrients, 12.","DOI":"10.3390\/nu12072099"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"111345","DOI":"10.1016\/j.nut.2021.111345","article-title":"Sarcopenia and prognosis of advanced cancer patients receiving immune checkpoint inhibitors: A comprehensive systematic review and meta-analysis","volume":"90","author":"Deng","year":"2021","journal-title":"Nutrition"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1016\/j.jtho.2019.05.031","article-title":"Body Mass Index (BMI), BMI Change, and Overall Survival in Patients with SCLC and NSCLC: A Pooled Analysis of the International Lung Cancer Consortium","volume":"14","author":"Shepshelovich","year":"2019","journal-title":"J. Thorac. Oncol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Nitsche, L.J., Mukherjee, S., Cheruvu, K., Krabak, C., Rachala, R., Ratnakaram, K., Sharma, P., Singh, M., and Yendamuri, S. (2022). Exploring the Impact of the Obesity Paradox on Lung Cancer and Other Malignancies. Cancers, 14.","DOI":"10.3390\/cancers14061440"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"2806","DOI":"10.21037\/jtd-22-1835","article-title":"Obesity and lung cancer\u2014A narrative review","volume":"15","author":"Vedire","year":"2023","journal-title":"J. Thorac. Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e20190450","DOI":"10.1084\/jem.20190450","article-title":"Tumor-derived IL-6 and trans-signaling among tumor, fat, and muscle mediate pancreatic cancer cachexia","volume":"218","author":"Rupert","year":"2021","journal-title":"J. Exp. Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12966-025-01719-6","article-title":"BMI or not to BMI? debating the value of body mass index as a measure of health in adults","volume":"22","author":"Shanks","year":"2025","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e13894","DOI":"10.1111\/obr.13894","article-title":"Validity of non-traditional measures of obesity compared to total body fat across the life course: A systematic review and meta-analysis","volume":"26","author":"Palumbo","year":"2025","journal-title":"Obes. Rev."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/17\/2765\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:32:23Z","timestamp":1760034743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/17\/2765"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":73,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["cancers17172765"],"URL":"https:\/\/doi.org\/10.3390\/cancers17172765","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]}}}