title: 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.
abstract: BACKGROUND
  A frequent manifestation of advanced NSCLC is malnutrition, even though there are many studies which relate it with a poor survival, its relation with toxicity has not yet been consistently reported. The aim of this study was to associate malnutrition and albumin serum levels with the occurrence of chemotherapy-induced toxicity in cisplatin plus paclitaxel chemotherapy-treated NSCLC.
  
  
  METHODS
  We prospectively evaluated 100 stage IV NSCLC patients treated with paclitaxel (175 mg/m2) and cisplatin (80 mg/m2). Malnutrition was assessed using SGA prior treatment. Neutrophil Lymphocyte Ratio (NLR) and the Platelet Lymphocyte Ratio (PLR) were used to determine the presence of systemic inflammatory response (SIR) and were related to the development of toxicity. Toxicity was graded according to NCI CTCAE version 3.0 after two chemotherapy cycles.
  
  
  RESULTS
  Median age was 58 +/- 10 years, 51% of patients were malnourished, 50% had albumin < or =3.0 mg/mL. NLR > or = 5 was associated with basal hypoalbuminemia (mean ranks, 55.7 vs. 39 p = 0.006), ECOG = 2 (47.2 vs. 55.4 p = 0.026) and PLR > or = 150 were significantly related with a basal body mass index < or =20 (56.6 vs. 43.5; p = 0.02) and hypoalbuminemia (58.9 vs. 41.3; p = 0.02). Main toxicities observed after 2 cycles of chemotherapy were alopecia (84%), nausea (49%), neuropathy (46%), anemia (33%), lymphopenia (31%), and leukopenia (30%). Patients malnourished and with hypoalbuminemia developed more chemotherapy-induced toxicity overall when compared with those without malnutrition (31 vs 22; p = 0.02) and normal albumin (mean ranks, 62 vs 43; p = 0.002), respectively. Hypoalbuminemia was associated with anemia (56 vs 47; p = 0.05), fatigue (58 vs 46; p = 0.01), and appetite loss (57.1 vs 46.7; p = 0.004) compared with normal albumin. PLR > or = 150 was related with the development of toxicity grade III/IV (59.27 vs. 47.03 p = 0.008) and anemia (37.9 vs 53.8 p = 0.004).
  
  
  CONCLUSIONS
  SIR parameters were associated with malnutrition, weight loss and hypoalbuminemia. Chemotherapy-induced toxicity in NSCLC patients treated with paclitaxel and cisplatin was associated with malnutrition and hypoalbuminemia. Early nutritional assessment and support might confer beneficial effects.
authors.affiliation: Medical Oncology Department Instituto Nacional de Cancerología Av San Fernando No 22, Col Sección XVI, Mexico City, 14080 Mexico. ogar@servidor.unam.mx
authors.forename: Oscar
authors.initials: O
authors.lastname: Arrieta
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Michel Ortega
authors.forename: Geraldine
authors.initials: G
authors.lastname: Villanueva-Rodríguez
authors.forename: Maria G
authors.initials: MG
authors.lastname: Serna-Thomé
authors.forename: Diana
authors.initials: D
authors.lastname: Flores-Estrada
authors.forename: Consuelo
authors.initials: C
authors.lastname: Diaz-Romero
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Rodríguez
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez
authors.forename: Karla
authors.initials: K
authors.lastname: Sánchez-Lara
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood*; D002945:Cisplatin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood*; D008214:Lymphocytes / Q000166:cytology; D008297:Male; D044342:Malnutrition / Q000517:prevention & control; D008875:Middle Aged; D009752:Nutritional Status; D017239:Paclitaxel / Q000008:administration & dosage*; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis*
chemical_list: D012709:Serum Albumin; D017239:Paclitaxel; D002945:Cisplatin