Cancer Cachexia Reduces the Efficacy of Nivolumab Treatment in Patients With Advanced Gastric Cancer

Anticancer Res. 2020 Dec;40(12):7067-7075. doi: 10.21873/anticanres.14734.


Background/aim: Nivolumab is effective against advanced gastric cancer (AGC) refractory to or in patients intolerant of standard chemotherapy. This study was designed to clarify the impact of cancer cachexia in patients with AGC who received nivolumab.

Patients and methods: We recruited AGC patients who were treated with nivolumab from October 2017 to December 2019. Clinical outcomes were compared between patients with and without cancer cachexia at the start of nivolumab. Cancer cachexia was defined as weight loss >5%; weight loss >2% and body mass index (BMI) <20; or sarcopenia and BMI <20. Primary endpoints were median overall survival (OS) and median time to treatment failure (TTF), while secondary endpoints were overall response rate (ORR) and incidence of adverse events.

Results: The study enrolled 44 patients. Median OS and TTF were significantly shorter in patients with cancer cachexia than in those without cancer cachexia (OS: 6.6 vs. 2.3 months; HR=2.65; 95%CI=1.28-5.49; p=0.008, TTF: 2.6 vs. 1.9 months; HR=2.17; 95%CI=1.09-4.32, p=0.027). On Cox proportional hazards analysis, cancer cachexia was significantly associated with shorter OS. The incidence of adverse events did not differ between the two groups. Nivolumab was associated with better OS and TTF outcomes in AGC patients without cachexia than in those with cachexia, albeit there was no difference in the incidence of adverse events.

Conclusion: Cancer cachexia may be associated with worse clinical outcomes in patients with AGC treated with nivolumab.

Keywords: Nivolumab; cancer cachexia; gastric cancer; overall survival; time to treatment failure.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents, Immunological / pharmacology
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Cachexia / etiology*
  • Cachexia / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nivolumab / pharmacology
  • Nivolumab / therapeutic use*
  • Retrospective Studies
  • Stomach Neoplasms / drug therapy


  • Antineoplastic Agents, Immunological
  • Nivolumab