Background Obesity has been linked to increased mortality in several cancer types; however, the relationship between obesity and survival in metastatic melanoma is unknown. The aim of this study was to examine the association between BMI, progression-free survival (PFS), and overall survival (OS) in metastatic melanoma. Methods This study included 6 independent cohorts for a total of 1918 metastatic melanoma patients. These included two targeted therapy cohorts [randomized control trials (RCTs) of dabrafenib and trametinib (n=599) and vemurafenib and cobimetinib (n=240)], two immunotherapy cohorts [RCT of ipilimumab + dacarbazine (DTIC) (n=207) and a retrospective cohort treated with anti-PD-1/PDL-1 (n=331)], and two chemotherapy cohorts [RCT DTIC cohorts (n=320 and n=221)]. BMI was classified as normal (BMI 18 to <25; n=694 of 1918, 36.1%) overweight (BMI 25-29.9; n=711, 37.1%) or obese (BMI≥30; n=513, 26.7%). The primary outcomes were the association between BMI, PFS, and OS, stratified by treatment type and sex. These exploratory analyses were based on previously reported intention-to-treat data from the RCTs. The effect of BMI on PFS and OS was assessed by multivariable-adjusted Cox models in independent cohorts. In order to provide a more precise estimate of the association between BMI and outcomes, as well as the interaction between BMI, sex, and therapy type, adjusted hazard ratios were combined in mixed-effects meta-analyses and heterogeneity was explored with meta-regression analyses. Findings In the pooled analysis, obesity, as compared to normal BMI, was associated with improved survival in patients with metastatic melanoma [average adjusted hazard ratio (HR) and 95% CI: 0.77 (0.66-0.90) and 0.74 (0.58-0.95) for PFS and OS, respectively]. The survival benefit associated with obesity was restricted to patients treated with targeted therapy [0.72 (0.57-0.91) and 0.60 (0.45-0.79) for PFS and OS, respectively] and immunotherapy [0.75 (0.56-1.00) and 0.64 (0.47-0.86)]. No associations were observed with chemotherapy [0.87 (0.65-1.17) and 1.03 (0.80-1.34); treatment p for interaction = 0.61 and 0.01, for PFS and OS, respectively]. The prognostic effect of BMI with targeted and immune therapies differed by sex with pronounced inverse associations in males [PFS 0.67 (0.53-0.84) and OS 0.53 (0.40-0.70)], but not females [PFS 0.92 (0.70-1.23) and OS 0.85 (0.61-1.18), sex p for interaction= 0.08 and 0.03, for PFS and OS, respectively] Interpretation Obesity is associated with improved PFS and OS in metastatic melanoma, driven by strong associations observed in males treated with targeted or immune therapy. The magnitude of the benefit detected supports the need for investigation into the underlying mechanism of these unexpected observations Funding ASCO/CCF Young Investigator Award and ASCO/CCF Career Development Award to JLM

Anti–programmed cell death protein‐1 (anti‐PD‐1) therapy has greatly improved outcomes of patients with melanoma; however, many fail to respond. Although preclinical studies suggest a potentially synergistic relationship with anti‐PD‐1 therapy and certain concurrent medications, their clinical role remains unclear. Here, we retrospectively evaluated the use of nonsteroidal anti‐inflammatory drugs (NSAIDs) and other drugs in 330 patients with melanoma treated with anti‐PD‐1 therapy from four academic centers. In the cohort, 37% of patients used NSAIDs including aspirin (acetylsalicylic acid; ASA; 47%), cyclooxygenase (COX)‐2 inhibitors (2%), and non‐ASA/nonselective COX inhibitor NSAIDs (59%). The objective response rates (ORRs) were similar in patients with NSAID (43.4%) and no NSAID (41.3%) use with no significant difference in overall suvival (OS). There was a trend toward improved progression‐free survival (PFS) in patients who took NSAIDs (median PFS: 8.5 vs. 5.2 months; p = .054). Most patients (71.3%) took NSAIDs once daily or as needed. Multivariate analysis did not reveal an association with NSAID use with ORR, PFS, or OS. Concurrent use of metformin or beta blockers did not affect ORR, PFS, or OS. Our study found no conclusive association of concurrent NSAID or other medication use with improved outcomes in patients with melanoma treated with anti‐PD‐1 therapy. Larger and more systematic analysis is required to confirm these findings.

the thigh it is split into anterior and posterior division by the lateral circumflex femoral artery. [1,2] The femoral nerve block is performed on the main stem of the nerve, inferior to the inguinal ligament, before it divides into anterior and posterior branches. [3] The femoral nerve originates from the second, third, and fourth lumbar spinal nerves and innervates the anterior thigh muscles, hip and knee joints, and skin on the anteromedial thigh. [3,4] The objective of this study was to dissect, identify, and document variations in the anatomy of the femoral nerve and its branching pattern. This knowledge could then be used to validate previously described anatomy and various surgical approaches to expose the femoral nerve. Background: Femoral nerve is used for nerve block in several surgeries. The knowledge of femoral nerve in thigh is important for anatomist, anesthetics, and surgeons to prevent iatrogenic femoral nerve palsy. We dissected 25 human cadavers to study the anatomy of femoral nerve. We dissected the femoral nerve bilaterally in Anatomy Department of Smt N H L Municipal Medical College, and recorded the branching pattern of femoral nerve with digital photography. Objective: To highlight the variation in branching pattern of the femoral nerve. Materials and Methods: We measured the distance from the anterior superior iliac spine (ASIS) to the pubic symphysis bilaterally on each cadaver as an anatomical landmark. We located the femoral nerve through transverse incisions from the ASIS to the pubic symphysis and incisions originating from the midpoint between the ASIS and the pubic symphysis extending longitudinally to the patella. We chose the inguinal ligament as a proximal limitation for dissection of the femoral nerve in the thigh. The distance from the inguinal ligament to the first branching point of the femoral nerve was measured. We traced and dissected all femoral nerve branches to the insertion points. Result: The mean medial-lateral distance from the ASIS to the pubic symphysis was 14.50 ± 1.34 cm (range 13-16). We found the femoral nerve near the midpoint, 46± 5% from the ASIS. We did not measure in cadaver specimen 5 since bony landmarks were difficult to palpate because of excessive adipose tissue. The distance from the inguinal ligament to the first branching point of the femoral nerve was 1.50 ± 0.47 cm (range 1-2cm). Conclusion: The anatomy and morphology we observed remained consistent with the established literature, suggesting that our chosen specimens did not differ from the standard population and that we may consider the results representative of the general population.