Sarcopenia, Elevated Body Mass Index, and Platinum-Associated Adverse Events in Patients With Lung Cancer

Background: Patients with sarcopenia and elevated body mass index (BMI) are at high risk of platinum-associated adverse events (AEs). This study examines the association between sarcopenia, BMI, and AEs in patients with non–small cell lung cancer (NSCLC). Methods: This retrospective cohort study included adult patients with NSCLC who started cisplatin or carboplatin between 2015 and 2022. Sarcopenia was defined on CT using sex-specific cutoffs for skeletal muscle index. We evaluated the association between CT-defined sarcopenia and grade ≥2 AEs (including anemia, thrombocytopenia, neutropenia, and increased creatinine), chemotherapy discontinuation, and 90-day mortality in patients with normal (<25 kg/m 2 ) and elevated (≥25 kg/m 2 ) BMI using a Fine-Gray subdistribution hazard model. The association between receiving an excess carboplatin dose and AEs was evaluated. Results: Of 604 included patients, the mean [SD] age was 66 [10] years, 307 (51%) were female, and 167 (28%) had sarcopenia. Sarcopenia and elevated BMI (n=67) was associated with an increased risk of grade ≥2 anemia (subdistribution hazard ratio [sHR], 1.64; 95% CI, 1.17–2.29; P =.004), thrombocytopenia (sHR, 2.25; 95% CI, 1.16–4.36; P =.016), and increased creatinine (sHR, 2.72; 95% CI, 1.45–5.13; P =.002). Sensitivity analyses demonstrated that patients whose Cockcroft-Gault–based glomerular filtration rate (GFR) dictated a carboplatin dose ≥25 mg higher than CKD-EPI GFR were at significantly higher risk of grade ≥2 AEs and chemotherapy discontinuation. Conclusions: Combined CT-defined sarcopenia with elevated BMI is associated with an increased risk of platinum-associated AEs in patients with NSCLC; this may be due to GFR misestimation in patients with low muscle mass and elevated BMI.