Impact of body mass index on survival rates in patients receiving immune checkpoint inhibitors.

Abstract

e15108 Background: Obesity is associated with 13 different cancer types, accounting for 40% of all cancers1. A few studies have linked a higher Body Mass Index (BMI) with longer Progression Free Survival (PFS) and Overall Survival (OS) from immune checkpoint inhibitors (CPI)s in patients with advanced melanoma, non-small cell lung cancer, and renal cell carcinoma2,3,4. Our study evaluates CPI efficacy in patients with multiple tumor types in relation to Body Mass Index (BMI). Methods: We retrospectively collected data from patients treated with CPIs alone who also received steroids during their treatment from a single institution. This data included demographics such as age, sex, and BMI. Response and progression were defined per RECIST v1.1. The association of BMI and PFS was assessed by exact chi-square test. Kaplan Meier and Cox proportional hazard regression methods were used to estimate the survival probability and hazard ratios. Results: We identified a total of 129 overweight or obese patients (49%) with stage IV cancer who received CPI therapy. CDC guidelines define overweight as BMI > 25 and obese as BMI > 30. There was a significant relationship between PFS and BMI. Median PFS for those overweight was 287 days and 479 days for obese. Those with BMI 18.5-25 (normal), median PFS was 128 days and 103 days for those underweight (BMI < 18.5), (p = .0024). There was also a significant relationship between OS and BMI. Median OS for those obese was 751 days, for those overweight was 462 days. Median OS for those normal weight was 281 days and those underweight was 273 days (p = .0005). Obese patients had a 48% reduced risk of progression of disease/death as compared to those who had normal BMI (Hazard Ratio 0.52, p = .019). Overweight had a 31.5% relative risk reduction (HR 0.685, p = .05). Overall Response Rate was not significant between the two groups but there was a strong trend (p = .087). Conclusions: Higher BMI was associated with improved PFS and OS in patients with metastatic cancer across 20 different tumor types. Further investigation into the immune mechanisms behind this may lead to improvement in CPI efficacy for all patients.

Obesity Is Associated with Immunometabolic Changes in Adipose Tissue That May Drive Treatment Resistance in Breast Cancer: Immune-Metabolic Reprogramming and Novel Therapeutic Strategies

“…This study showed improved clinical outcomes in patients with high BMI who were treated with ICPIs compared to patients with healthy BMI with no statistically significant difference in the frequency of immune-related adverse events [95]. This observation is supported by Maslov et al, who demonstrated that high BMI in patients with metastatic cancer, across 20 different tumour types, is associated with a 48% lower risk of disease progression or death compared to patients with healthy BMI [96]. In addition, in a cohort of 250 patients diagnosed with several types of cancers who were treated with ICPIs, individuals with a BMI ≥ 30 had significantly better progression-free survival and OS compared to patients without obesity [31].…”

Obesity Is Associated With Immunometabolic Changes in Adi-Pose Tissue That May Drive Treatment Resistance in Breast Cancer: Immune-Metabolic Reprogramming and Novel Therapeutic Strategies

“…This observation is supported by Maslov et. al., who demonstrated that high BMI in patients with metastatic cancer, across 20 different tumour types, is associated with a 48% lower risk of disease progression or death compared to patients with healthy BMI [76]. In addition, in a cohort of 250 patients diagnosed with different types of cancers who were treated with ICPI, individuals with a BMI ≥30 had significantly better progression-free survival and OS compared to patients without obesity [50].…”

Obesity Is Associated With Immunometabolic Changes in Adipose Tissue That May Drive Treatment Resistance in Breast Cancer: Immune-Metabolic Reprogramming and Novel Therapeutic Strategies

“…This observation is supported by Maslov et. al., who demonstrated that high BMI in patients with metastatic cancer, across 20 different tumour types, is associated with a 48% lower risk of disease progression or death compared to patients with healthy BMI (69). In addition, in a cohort of 250 patients diagnosed with several types of cancers who were treated with ICPI, individuals with a BMI ≥30 had significantly better progression-free survival and OS compared to patients without obesity (70).…”