Abstract
Dear Editor,
Non–small-cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer cases worldwide and remains a leading cause of cancer-related morbidity and mortality. Malnutrition is highly prevalent in this population, affecting between 35% and 65% of patients, and is associated with impaired quality of life, reduced survival, and poorer tolerance to anticancer treatments. 1 However, nutritional and functional assessments are still not routinely integrated into pharmacotherapeutic follow-up in daily clinical practice.
In a recent study published in Nutrients, 2 we evaluated nutritional status, body composition, and muscle function in 25 patients with NSCLC receiving osimertinib who were followed in a hospital pharmacy outpatient clinic. Nutritional status was assessed using validated screening tools, while body composition and muscle function were evaluated through bioelectrical impedance analysis and handgrip dynamometry. We observed that 36% of patients were malnourished, 4% had sarcopenia, 8% presarcopenia, and 20% dynapenia, defined as reduced muscle strength regardless of muscle mass.
Patients who developed dose-limiting toxicities showed significantly lower fat-free mass and fat-free mass index, as well as poorer muscle strength values. These findings suggest that reduced muscle mass and impaired muscle function may be associated with an increased risk of clinically relevant toxicity during osimertinib treatment. 2 This observation is particularly relevant, as tyrosine kinase inhibitors, including osimertinib, may interfere with anabolic pathways essential for skeletal muscle maintenance, potentially accelerating muscle loss and increasing treatment-related toxicity. 3
Recent evidence describing a high prevalence of weight loss in patients treated with osimertinib and its association with worse clinical outcomes further supports the need for systematic nutritional and functional monitoring throughout treatment. 4 Early identification of patients at risk may allow timely interventions aimed at preserving muscle mass, improving functional status, and maintaining treatment intensity.
From a hospital pharmacy perspective, outpatient oncology clinics within the hospital pharmacy service, where osimertinib is dispensed and pharmacotherapeutic follow-up is performed, represent an optimal setting for the implementation of simple, accessible, and reproducible tools, such as handgrip dynamometry and bioelectrical impedance analysis. In this context, hospital pharmacists are well positioned to integrate these assessments into routine follow-up, enabling early detection of malnutrition, sarcopenia, and dynapenia and facilitating multidisciplinary management in collaboration with oncology, endocrinology, and nutrition specialists, supporting early identification and appropriate referral.
We believe that incorporating nutritional and functional assessment into routine pharmacy practice may contribute to improved treatment tolerance, reduced toxicity, enhanced adherence, and better clinical outcomes in patients with NSCLC receiving osimertinib. Further multicentre studies are warranted to confirm these findings and support their broader implementation in hospital pharmacy practice.
