Chemotherapy intolerance in metastatic non-small cell lung cancer: the role of nutritional status

Year 2026, Volume: 8 Issue: 2, 224 - 230, 10.03.2026

Aykut Turhan , Mehmet Emin Büyükbayram

https://doi.org/10.38053/acmj.1855838

https://izlik.org/JA94RF43NR

Abstract

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<0.001), serum albumin (p=0.001), and BMI (p=0.009) than the chemotherapy-tolerant group. Weight loss (71.4% vs. 36.2%, p=0.002), low serum albumin (<3.5 g/dl, p=0.004), and anemia (p=0.002) were more prevalent in the chemotherapy-intolerant group. In the multivariate analysis, weight loss (odds ratio [OR]=3.28, 95% confidence interval [CI]: 1.07-10.03, p=0.039), anemia (OR=4.62, 95% CI: 1.36-15.67, p=0.014), and low serum albumin (OR=5.06, 95% CI: 1.19-21.42, p=0.030) were independently associated with chemotherapy intolerance.
Conclusion: Baseline nutritional status, particularly weight loss, anemia, and hypoalbuminemia, is independently associated with chemotherapy intolerance in patients with metastatic NSCLC receiving first-line paclitaxel–carboplatin therapy. These findings highlight the importance of nutritional assessment and support in optimizing chemotherapy and patient outcomes.

Keywords

Chemotherapy intolerance , non-small cell lung cancer , nutritional status , hemoglobin , weight loss , albumin , body mass index

Thanks

We would like to thank the Editor-in-Chief and the editorial team of the Anatolian Current Medical Journal for their time and consideration of our manuscript. We appreciate the opportunity to submit our work to your respected journal

References

• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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