Association between Body Mass Index and Immune-Related Adverse Events (irAEs) among Advanced-Stage Cancer Patients Receiving Immune Checkpoint Inhibitors: A Pan-Cancer Analysis

Abstract

Evidence regarding the association between body mass index (BMI) and immune-related adverse events (irAEs) among cancer patients receiving immune checkpoint inhibitors (ICIs) is limited. Here, we use cross-sectional hospital-based data to explore their relationship. Pre-treatment BMI was treated as an ordinal variable (<25, 25 to ≤30, ≥30 kg/m2). The outcome of interest was irAEs after ICI initiation. A multivariable logistic regression model estimated the adjusted odds ratio (aOR) and 95% confidence interval (CI) of BMI. A total of 684 patients with stage III or IV cancer were included in the study (lung: 269, melanoma: 204, other: 211). The mean age at the first dose of ICI was 64.1 years (SD = 13.5), 394 patients (57.6%) were male, and over one-third (N = 260, 38.0%) were non-White. Overall, 52.9% of patients had BMI ≥ 25 kg/m2 (25 to ≤30: 217, ≥30: 145) and 288 (42.1%) had irAEs after ICI treatment. Patients with higher BMI tended to have a higher rate of irAEs (<25: 35.7%, 25 to ≤30: 47.0%, ≥30: 49.0%). The multivariable logistic regression yielded consistent results (BMI ≥ 30 vs. BMI < 25: aOR = 1.47, 95% CI = 0.96–2.23; 25 ≤ BMI < 30 vs. BMI < 25: aOR = 1.46, 95% CI = 1.02–2.11, p-trend = 0.04). In conclusion, among patients with advanced cancer receiving ICIs, the rate of irAEs appears to be higher among those with higher BMI.

Serum cholesterol-riched apolipoprotein-B (apoB) containing lipoproteins predict the response to immune checkpoints inhibitors (ICIs) in non-small cell lung cancer (NSCLC) : A retrospective analysis

“…Despite the prevalence of BMI was not signi cantly different according to the irAEs in this study, past studies demonstrated that higher pre-treatment BMI elevated the occurrence of any grade of irAEs (9)(10).…”

Serum cholesterol-riched apolipoprotein-B (apoB) containing lipoproteins predict the response to immune checkpoints inhibitors (ICIs) in non-small cell lung cancer (NSCLC) : A retrospective analysis

“…Another Japanese researcher chose BMI ≥ 21.4 kg/m 2 as the cut point and distinguished this cohort as a potential ICIs monotherapy bene ted subgroup, which indicated a race-tted BMI threshold might be necessary ( 34 ). Despite the prevalence of BMI was not signi cantly different according to the irAEs in this study, past studies demonstrated that higher pre-treatment BMI elevated the occurrence of any grade of irAEs (9)(10). Summarily, different from ICIs monotherapy, the overweight subgroup might not gain the bene t from the chemotherapy combining regimen in the Chinese NSCLC patients, whereas patients with a normal weight would be the lucky one.…”

Risk factors indicating immune-related adverse events with combination chemotherapy with immune checkpoint inhibitors and platinum agents in patients with non-small cell lung cancer: A multicenter retrospective study

“…To identify the factors associated with irAEs, an univariate analysis was performed using sex, age (< 65 years or over), BMI (< 25 kg/m 2 or over), ECOG-PS (0, 1, or over), smoking status (ever or never), histology (squamous or non-squamous), epidermal growth factor receptor (EGFR) mutation, TPS, ICI (anti-PD-1 antibody + anti-CTLA-4 antibody or anti-PD-1 antibody/anti-PD-L1 antibody), chemotherapy history, thoracic radiotherapy history, tyrosine kinase inhibitor history, corticosteroid use at baseline, ALB(< 3.6 g/dL or over), total bilirubin (< 1.5 mg/dL or over), aspartate aminotransferase (< 30 U/L or over), alanine aminotransferase (< 42 U/L or over), γglutamyl transpeptidase (< 64 U/L or over), blood urea nitrogen (< 20 mg/dL or over), CCr (< 60 mL/min or over ), PNI (< 40 or over), NLR (< 3 or over), and PLR (< 180 or over) as independent variables. The cut-off values for ALB [8], BMI [7], ECOG-PS [8], CCr [16], PNI [15], NLR [5,6], and PLR [17] were determined based on previous reports, and other factors of peripheral blood data were determined based on the normal range in the national hospital organization Beppu medical center. Differences between each factor were tested for statistical signi cance (P < 0.15) using the Fisher's exact test.…”