Pretreatment body mass index predicts survival among patients administered nivolumab monotherapy for pretreated non‐small cell lung cancer

Abstract

Background Biomarker assessments for nivolumab monotherapy efficacy in previously treated patients with non‐small cell lung cancer (NSCLC) remain unclear. We evaluated whether body mass index (BMI) and Glasgow prognostic score (GPS) are useful for assessing the efficacy of nivolumab alone as a second‐line treatment in patients with pretreated NSCLC. Methods Data of 99 patients treated with second‐line nivolumab monotherapy for NSCLC between January 2016 and December 2019 were evaluated for prognostic values of BMI and GPS to assess their usefulness in predicting progression‐free survival (PFS) and overall survival (OS). Results The Eastern Cooperative Oncology Group‐performance status (PS) independently predicted the second‐line nivolumab monotherapeutic effect; good PS (0–1) correlated with significantly longer PFS (4.3 vs. 1.9 months, log‐rank; p = 0.0004) and OS (17.7 vs. 4.6 months, log‐rank; p < 0.0001) than poor PS. BMI independently predicted survival, with high BMI (≥22.1 kg/m2) associated with significantly longer OS (19.1 vs. 8.5 months, log‐rank; p = 0.0023) than low BMI (<22.1 kg/m2). However, GPS showed no significant difference for PFS or OS. Conclusion Among patients with NSCLC treated with nivolumab monotherapy as second‐line treatment, PS was significantly correlated with both PFS and OS and BMI with OS. Thus, BMI could be a useful predictor of survival in these patients.

Body mass index, weight change, and cancer prognosis: a meta-analysis and systematic review of 73 cohort studies

“… 117 Furthermore, a study on patients with non-small-cell lung cancer receiving sodium butyrate monotherapy as second-line treatment found that BMI was significantly associated with OS, with higher BMI being associated with longer survival than lower BMI. 118 BMI <18.5 kg/m 2 was independently associated with tolerance to radiotherapy (concurrent chemoradiotherapy; OR 0.36), and intolerance to concurrent chemoradiotherapy was independently associated with poorer survival. 119 However, because smoking is an important risk factor for lung cancer and smokers tend to have a lower BMI, this may confound the association between BMI and cancer survival.…”

The Glasgow Prognostic Score Predicts Outcomes of Pembrolizumab or Atezolizumab Monotherapy in Patients with Pretreated Non-Small Cell Lung Cancer

“…Several previous studies revealed that the BMI was significantly correlated with the OS of patients with NSCLC who were treated with second- or subsequent-line ICIs, as patients with high BMIs experienced more favorable outcomes [ 18 , 31 , 32 ]. While our multivariate analysis revealed that the BMI tended to be associated with OS, the correlation was not significant in our analysis like it was in previous study [ 18 ].…”

“…Several previous studies revealed that the BMI was significantly correlated with the OS of patients with NSCLC who were treated with second- or subsequent-line ICIs, as patients with high BMIs experienced more favorable outcomes [ 18 , 31 , 32 ]. While our multivariate analysis revealed that the BMI tended to be associated with OS, the correlation was not significant in our analysis like it was in previous study [ 18 ]. The reason for this inconsistency may be the small number of patients in our study as well as the influence of previous treatments, given that the ICI in our study was administered as a second- or subsequent-line treatment.…”

“…However, most previous studies investigated the relationship between the GPS and efficacy of several types of ICIs, in patients who had undergone various treatment lines for NSCLC [ 12 , 17 ]; conversely, few studies have evaluated the relationship between the GPS and efficacy of pembrolizumab or atezolizumab monotherapy, as second- or subsequent-line treatment for NSCLC. Additionally, previous studies found that the BMI was a prognostic factor in patients with various types of cancer [ 5 ] and that it correlated with the effectiveness of ICI therapies against solid tumors including NSCLC [ 18 ]. However, it remains unclear whether the GPS can be an independent predictor of PFS and OS following ICI monotherapy after adjusting for BMI.…”

Potential roles of sex-linked differences in obesity and cancer immunotherapy: revisiting the obesity paradox

“…Some cancers, like non-small cell lung cancer (NSCLC) and melanoma, have been shown by multiple studies to promote the obesity paradox 16,17,21,82,84,[92][93][94][95] . Other cancers, such as renal cell carcinoma (RCC), have had several studies conducted indicating that obesity is not associated with improved survival, predictive of ICI response, or is even associated with poorer outcome 51,90,91 .…”