ACMJ

Anatolian Current Medical Journal (ACMJ) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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Original Article
Chemotherapy intolerance in metastatic non-small cell lung cancer: the role of nutritional status
Aims: Chemotherapy intolerance is a significant clinical challenge in metastatic non-small cell lung cancer (NSCLC) treatment, affecting treatment delivery, response, and quality of life. This study aimed to assess the association between baseline nutritional indicators and chemotherapy intolerance in patients with metastatic NSCLC receiving first-line paclitaxel-carboplatin chemotherapy. Methods: In this retrospective observational study, 82 patients with histologically confirmed metastatic NSCLC treated with first-line paclitaxel-carboplatin chemotherapy were enrolled. Baseline nutritional status was assessed using serum albumin, hemoglobin, body mass index (BMI), and unintentional weight loss measurements. Chemotherapy intolerance was defined as the inability to tolerate the planned chemotherapy regimen, necessitating treatment modification, including dose reduction due to treatment-related toxicity, treatment delays of ?7 days, or temporary discontinuation because of grade 3-4 adverse events. Univariate and multivariate logistic regression analyses were performed to identify the predictors of chemotherapy intolerance. Results: Chemotherapy intolerance was observed in 35 patients (42.7%). The chemotherapy-intolerant group had significantly lower median hemoglobin (p


1. Leiter A, Veluswamy RR, Wisnivesky JP. The global burden of lung cancer: current status and future trends. Nat Rev Clin Oncol. 2023;20(9): 624-639. doi:10.1038/s41571-023-00798-3
2. Zhou J, Xu Y, Liu J, Feng L, Yu J, Chen D. Global burden of lung cancer in 2022 and projections to 2050: incidence and mortality estimates from GLOBOCAN. Cancer Epidemiol. 2024;93:102693. doi:10.1016/j.canep. 2024.102693
3. Rodak O, Peris-Diaz MD, Olbromski M, Podhorska-Okolow M, Dziegiel P. Current landscape of non-small cell lung cancer: epidemiology, histological classification, targeted therapies, and immunotherapy. Cancers (Basel). 2021;13(18):4705. doi:10.3390/cancers13184705
4. Molina JR, Yang P, Cassivi SD, Schild SE, Adjei AA. Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship. Mayo Clin Proc. 2008;83(5):584-594. doi:10.4065/83.5.584
5. Arbour KC, Riely GJ. Systemic Therapy for locally advanced and metastatic non-small cell lung cancer: a review. JAMA. 2019;322(8):764-774. doi:10.1001/jama.2019.11058
6. Lyman GH. Impact of chemotherapy dose intensity on cancer patient outcomes. J Natl Compr Canc Netw. 2009;7(1):99-108. doi:10.6004/jnccn.2009.0009
7. Wagland R, Richardson A, Ewings S, et al. Prevalence of cancer chemotherapy-related problems, their relation to health-related quality of life and associated supportive care: a cross-sectional survey. Support Care Cancer. 2016;24(12):4901-4911. doi:10.1007/s00520-016-3346-4
8. Kuderer NM, Desai A, Lustberg MB, Lyman GH. Mitigating acute chemotherapy-associated adverse events in patients with cancer. Nat Rev Clin Oncol. 2022;19(11):681-697. doi:10.1038/s41571-022-00685-3
9. Ballatori E, Roila F. Impact of nausea and vomiting on quality of life in cancer patients during chemotherapy. Health Qual Life Outcomes. 17 20 03;1(1):46. doi:10.1186/1477-7525-1-46
10. Llopis-Salvia P, Sarrio-Montes G, Garcia-Llopis P, Bargues-Ruiz A. Chemotherapy dose intensity reductions due to adverse drug reactions in an oncology outpatient setting. J Oncol Pharm Pract. 2010;16(4):256-261. doi:10.1177/1078155209355848
11. SjOgren K, Jacobsen KA, GrOnberg BH, Halvorsen TO. Timing of severe toxicity from chemotherapy in patients with lung cancer. Anticancer Res. 2020;40(11):6399-6406. doi:10.21873/anticanres.14661
12. Kalsi T, Babic-Illman G, Fields P, et al. The impact of low-grade toxicity in older people with cancer undergoing chemotherapy. Br J Cancer. 2014;111(12):2224-2228. doi:10.1038/bjc.2014.496
13. Boguszewicz L. Predictive biomarkers for response and toxicity of induction chemotherapy in head and neck cancers. review. Front Oncol. 2022;12:900903. doi:10.3389/fonc.2022.900903
14. Kim J, Hurria A. Determining chemotherapy tolerance in older patients with cancer. J Natl Compr Canc Netw. 2013;11(12):1494-1502. doi:10. 6004/jnccn.2013.0176
15. Arends J, Baracos V, Bertz H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017;36(5):1187-1196. doi:10.1016/j.clnu.2017.06.017
16. Santarpia L, Contaldo F, Pasanisi F. Nutritional screening and early treatment of malnutrition in cancer patients. J Cachexia Sarcopenia Muscle. 2011;2(1):27-35. doi:10.1007/s13539-011-0022-x
17. Ruan GT, Ge YZ, Xie HL, et al. Association between systemic inflammation and malnutrition with survival in patients with cancer sarcopenia-a prospective multicenter study. original research. Front Nutr. 2021;8:811288. doi:10.3389/fnut.2021.811288
18. Roxburgh CS, McMillan DC. Cancer and systemic inflammation: treat the tumour and treat the host. Br J Cancer. 2014;110(6):1409-1412. doi:10.1038/bjc.2014.90
19. Perez-Pitarch A, Guglieri-Lopez B, Nacher A, Merino V, Merino-Sanjuan M. Impact of undernutrition on the pharmacokinetics and pharmacodynamics of anticancer drugs: a literature review. Nutr Cancer. 2017;69(4):555–563. doi:10.1080/01635581.2017.1299878
20. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11-48. doi:10.1016/j.clnu.2016. 07.015
21. Ikeda S, Yoshioka H, Ikeo S, et al. Serum albumin level as a potential marker for deciding chemotherapy or best supportive care in elderly, advanced non-small cell lung cancer patients with poor performance status. BMC Cancer. 2017;17(1):797. doi:10.1186/s12885-017-3814-3
22. Ross PJ, Ashley S, Norton A, et al. Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer. 2004;90(10):1905-1911. doi:10.1038/sj.bjc.6601781
23. Lin T, Yang J, Hong X, Yang Z, Ge T, Wang M. Nutritional status in patients with advanced lung cancer undergoing chemotherapy: a prospective observational study. Nutr Cancer. 2020;72(7):1225-1230. doi:10.1080/01635581.2019.1675720
24. Nadler E, Arondekar B, Aguilar KM, et al. Treatment patterns and clinical outcomes in patients with advanced non-small cell lung cancer initiating first-line treatment in the US community oncology setting: a real-world retrospective observational study. J Cancer Res Clin Oncol. 2021;147(3):671-690. doi:10.1007/s00432-020-03414-4
25. Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG. Role of nutritional status in predicting quality of life outcomes in cancer--a systematic review of the epidemiological literature. Nutr J. 2012;11(1):27. doi:10.1186/1475-2891-11-27
26. Adam R, Haileselassie W, Solomon N, et al. Nutritional status and quality of life among breast Cancer patients undergoing treatment in Addis Ababa, Ethiopia. BMC Womens Health. 2023;23(1):428. doi:10. 1186/s12905-023-02585-9
27. Zhang Y, Kong FF, Zhu ZQ, Shan HX. Controlling Nutritional Status (CONUT) score is a prognostic marker in III-IV NSCLC patients receiving first-line chemotherapy. BMC Cancer. 2023;23(1):225. doi:10. 1186/s12885-023-10682-z
28. Gouez M, Delrieu L, Bouleuc C, Girard N, Raynard B, Marchal T. Association between nutritional status and treatment response and survival in patients treated with immunotherapy for lung cancer: a retrospective french study. Cancers (Basel). 2022;14(14):3439. doi:10. 3390/cancers14143439
29. Park S, Park S, Lee SH, et al. Nutritional status in the era of target therapy: poor nutrition is a prognostic factor in non-small cell lung cancer with activating epidermal growth factor receptor mutations. Korean J Intern Med. 2016;31(6):1140-1149. doi:10.3904/kjim.2015.062
30. Arrieta O, Michel Ortega RM, Villanueva-Rodriguez G, et al. Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study. BMC Cancer. 2010;10:50. doi:10.1186/1471-2407-10-50
31. Karabulut S, Dogan I, Usul Afsar C, et al. Does nutritional status affect treatment tolarability, response and survival in metastatic colorectal cancer patients? Results of a prospective multicenter study. J Oncol Pharm Pract. 2021;27(6):1357-1363. doi:10.1177/1078155220959427
32. Dunne RF, Loh KP, Williams GR, Jatoi A, Mustian KM, Mohile SG. Cachexia and sarcopenia in older adults with cancer: a comprehensive review. Cancers (Basel). 2019;11(12):1861. doi:10.3390/cancers11121861
33. Papadopoulos E, Irving BA, Brown JC, et al. Sarcopenia and cachexia in older patients with cancer: pathophysiology, diagnosis, impact on outcomes, and management strategies. Drugs Aging. 2025;42(12):1113-1142. doi:10.1007/s40266-025-01252-y
34. Ryan AM, Power DG, Daly L, Cushen SJ, Ni Bhuachalla E, Prado CM. Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc. 2016;75(2):199-211. doi:10.1017/S002966511500419X
35. Blohmer JU, Dunst J, Harrison L, et al. Cancer-related anemia: biological findings, clinical implications and impact on quality of life. Oncology. 2005;68 Suppl 1:12-21. doi:10.1159/000083129
36. Cella D, Kallich J, McDermott A, Xu X. The longitudinal relationship of hemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials. Ann Oncol. 2004;15(6):979-986. doi:10.1093/annonc/mdh235
37. Idasiak-Piechocka I, Lewandowski D, Swigut W, et al. Effect of hypoalbuminemia on drug pharmacokinetics. review. Front Pharmacol. 2025;16:1546465. doi:10.3389/fphar.2025.1546465
38. Gandia P, Decheiver S, Picard M, Guilhaumou R, Baklouti S, Concordet D. Hypoalbuminemia and pharmacokinetics: when the misunderstanding of a fundamental concept leads to repeated errors over decades. Antibiotics (Basel). 2023;12(3):515. doi:10.3390/antibiotics12030515
39. Polanski J, Chabowski M, Swiatoniowska-Lonc N, et al. Relationship between nutritional status and clinical outcome in patients treated for lung cancer. Nutrients. 2021;13(10):3332. doi:10.3390/nu13103332
40. Trestini I, Sperduti I, Sposito M, et al. Evaluation of nutritional status in non-small-cell lung cancer: screening, assessment and correlation with treatment outcome. ESMO Open. 2020;5(3):e000689. doi:10.1136/esmoopen-2020-000689
Volume 8, Issue 2, 2026
Page : 224-230
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