Evaluating oral nutritional support and the nutritional risk scores in ICI-treated metastatic solid tumours.

BACKGROUND

Malnutrition is common in metastatic cancer and may compromise outcomes. We evaluated whether oral nutritional supplementation (ONS) improves survival and compared the performance of nutritional risk scores in immune checkpoint inhibitor (ICI)-treated patients.

METHODS

We retrospectively analyzed 538 adults with metastatic solid tumors who initiated ICIs between 2015 and 2024. Baseline ONS use, clinicopathological variables, and laboratory parameters were recorded. Survival outcomes were assessed after 1:1 propensity score matching (PSM).

RESULTS

246 matched patients were evaluated. ONS was not associated with better overall survival (OS: median 13.9 vs 11.0 months; p = 0.70) or progression-free survival (PFS: 3.4 vs 4.4 months; p = 0.11). Immune-related adverse events (irAEs) occurred in 40.2% of ONS users versus 34.0% of non-users (p = 0.469). The Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, and modified Glasgow Prognostic Score (mGPS) independently predicted OS and PFS (all p < 0.001), with PNI and mGPS showing the best discrimination. Subgroup analyses across nutritional scores revealed no survival benefit with ONS.

CONCLUSIONS

ONS did not improve survival or rates of irAEs in metastatic patients receiving ICIs, whereas nutritional scores provided strong prognostic stratification. Prospective trials integrating longitudinal nutrition monitoring, immunonutrition, and multimodal cachexia therapy are warranted.