Impact of Sarcopenia on Chemotherapy Toxicity in Elderly Patients with Non-Small Cell Lung Cancer: A Systematic Review

Abstract

Background: Sarcopenia, characterized by progressive loss of skeletal muscle mass and function, is increasingly recognized as a key determinant of outcomes in cancer patients. Elderly patients with non-small cell lung cancer (NSCLC) are particularly vulnerable to chemotherapy-related toxicity, yet traditional assessment tools inadequately capture frailty. Emerging evidence suggests that sarcopenia may serve as a robust predictor of treatment-related adverse events.

Objective: To evaluate the impact of sarcopenia on chemotherapy toxicity in elderly patients with NSCLC and explore its role as a predictive biomarker for treatment outcomes.

Methods: A systematic review of published literature was conducted focusing on studies assessing sarcopenia and chemotherapy toxicity in elderly NSCLC populations. Databases were searched for relevant observational and clinical studies. Outcomes included incidence of grade ≥3 toxicity, dose reductions, treatment discontinuation, and hospitalization rates.

Results: Sarcopenia was consistently associated with increased chemotherapy toxicity, including higher rates of grade 3–5 adverse events, treatment modifications, and hospitalizations. Studies reported that sarcopenic patients had up to twofold increased risk of severe toxicity. Additionally, sarcopenia correlated with reduced treatment tolerance and poorer survival outcomes.

Conclusion: Sarcopenia is a significant predictor of chemotherapy toxicity in elderly NSCLC patients. Incorporating body composition assessment into routine oncologic evaluation may enhance risk stratification and guide personalized treatment strategies.