Body mass index, as a novel predictor of hepatocellular carcinoma patients treated with Anti-PD-1 immunotherapy

Abstract

Immunocheckpoint inhibitors have shown significant efficacy in the treatment of hepatocellular carcinoma (HCC), but there are individual differences. The aim of this study was to explore body mass index (BMI) as a predictor of anti-PD-1 efficacy in patients with HCC. We retrospectively analyzed 101 HCC patients who treated with anti-PD-1 at Sun Yat-sen University Cancer Center from July 2018 to November 2019 and divided them into overweight (BMI > 24.9) and non-overweight (BMI ≤ 24.9) groups based on baseline BMI levels. BMI > 24.9 accounted for 22 cases (21.8%) and BMI ≤ 24.9 accounted for 79 cases (78.2%) in the study cohort. Overweight patients had higher disease control rates than non-overweight patients (P = 0.019, respectively). The mean progression-free survival (PFS) in overweight patients (10.23 months) was significantly longer than that of non-overweight patients (6.85 months; P = 0.027). Among patients with immune-related adverse events (irAEs), the mean PFS was also significantly longer in overweight patients (7.72 months) than in non-overweight patients (5.31 months, P = 0.034). Multivariate analysis showed that BMI was an independent prognostic factor for PFS in HCC patients treated with anti-PD-1 (hazard ratio: 0.47, P = 0.044). Thus, higher BMI predicts a better prognosis among HCC patients treated with anti-PD-1. In clinical practice, patients' BMI can provide a useful tool for predicting the efficacy of anti-PD-1 therapy.

Impact of body mass index on the prognosis of unresectable HCC patients receiving first‐line Lenvatinib or atezolizumab plus bevacizumab

“…Previous evidences on the role of BMI in HCC patients who received atezolizumab plus bevacizumab are quite scarce and inconclusive. Chen and collaborators highlighted the positive prognostic role of high BMI in a cohort of patients affected by advanced HCC who received immunotherapy, consistently with our results 24 . On the other hand, Vithayathil and colleagues performed a retrospective analysis in patients who received atezolizumab plus bevacizumab, reporting comparable survival in overweight and non‐overweight patients, with the overweight experiencing a higher incidence of fatigue compared to the non‐overweight 25 .…”

“…Chen and collaborators highlighted the positive prognostic role of high BMI in a cohort of patients affected by advanced HCC who received immunotherapy, consistently with our results. 24 On the other hand, Vithayathil and colleagues performed a retrospective analysis in patients who received atezolizumab plus bevacizumab, reporting comparable survival in overweight and non-overweight patients, with the overweight experiencing a higher incidence of fatigue compared to the non-overweight. 25 Differences between the present findings and the previous ones could be ascribed to the differences in both sample sizes and baseline characteristics of the cohorts.…”

“…Recently, Chen and colleagues retrospectively analysed 101 HCC patients who received immunotherapy, and highlighted that a higher BMI confers better prognosis in terms of both PFS and OS in this setting of patients. 24 Contrarily, Vithayathil and colleagues recently reported a comparable efficacy in overweight HCC patients compared to normal weight when receiving atezolizumab plus bevacizumab, with a major incidence of treatment-related fatigue in overweight patients. 25 Unfortunately, these data are not conclusive and deeper investigation on large sample are needed in order to define the role of BMI in this setting of patients.…”

The impact of body mass index on survival endpoints among patients with metastatic urothelial carcinoma undergoing treatment with immune checkpoint inhibitors: A real‐world multicenter analysis

“…In several cancer types, including non-small lung cancer (NSCLC), head and neck squamous cell carcinoma (HNSCC), and hepatocellular carcinoma (HCC), high BMI has been associated with better overall survival (OS). [20][21][22] Conversely, obese patients with renal cell carcinoma (RCC) have a significantly worse OS than normal weight patients. 23 With regard to the relationship between BMI and survival in metastatic urothelial carcinoma (mUC), limited studies have addressed this issue.…”

“…However, whether BMI is a prognostic factor in the era of cancer treatment shifting toward immunotherapy remains unknown. In several cancer types, including non‐small lung cancer (NSCLC), head and neck squamous cell carcinoma (HNSCC), and hepatocellular carcinoma (HCC), high BMI has been associated with better overall survival (OS) 20–22 . Conversely, obese patients with renal cell carcinoma (RCC) have a significantly worse OS than normal weight patients 23 .…”