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. 2024 Sep;81(4):356-370.
doi: 10.1111/1747-0080.12879. Epub 2024 May 28.

The nutrition-related adverse events associated with immune checkpoint inhibitor treatment for patients with non-small cell lung cancer: A systematic review

Kate L Graham  1 , Danika Carty  1 , Shay P Poulter  2 , Chantal Blackman  2 , Olivia G Dunstan  2 , Taryn L Milton  2 , Cassie Ferguson  2 , Kaitlyn Smith  2 , Emilly Van Dijk  2 , Darcy Jongebloed  1 , Jenelle Loeliger  1   3 , Brenton J Baguley  2   3
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The nutrition-related adverse events associated with immune checkpoint inhibitor treatment for patients with non-small cell lung cancer: A systematic review

Kate L Graham et al. Nutr Diet. 2024 Sep.

Abstract

Aims: Immune checkpoint inhibitor therapy used for lung cancer has significantly changed response and survival rates, however, the impact on patients' nutritional status remains largely unexplored. This review aims to identify common adverse events that increase nutrition risk induced in non-small cell lung cancer patients treated with immune checkpoint inhibitor therapy and assess impact on nutritional status.

Methods: PubMed, Medline and CINAHL were systematically searched in September 2023 for randomised controlled trials comparing immune checkpoint inhibitor treatment of non-small cell lung cancer to a control group. Treatment-related adverse events that increased nutrition impact symptoms identified in the patient-generated subjective global assessment and clinical guidelines were extracted and qualitatively analysed. Risk of bias was assessed using Cochrane Risk of Bias tool 2.

Results: Eleven eligible randomised controlled trial studies were identified and analysed. The data demonstrated immune checkpoint inhibitor treatment was associated with a lower percentage of reported nutrition impact symptoms, for example, decreased appetite, nausea, vomiting, compared to chemotherapy treatment. Conversely, immune checkpoint inhibitor treated patients recorded a greater percentage of immune-related adverse events that alter metabolism or nutrient absorption.

Conclusion: Non-small cell lung cancer patients treated with immune checkpoint inhibitors still experience nutrition impact symptoms but less frequently than patients treated with chemotherapy. This combined with unique nutrition-related consequences from colitis and thyroid disorders induced by immune checkpoint inhibitor therapy indicates patients should be screened, assessed and interventions implemented to improve nutrition.

Keywords: immune checkpoint inhibitors; immunotherapy; malnutrition; non‐small cell lung cancer; nutrition impact symptoms; randomised control trials; treatment related adverse events.

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