The association between body mass index and efficacy of pembrolizumab as second‐line therapy in patients with recurrent/metastatic head and neck squamous cell carcinoma

Abstract

Background Recent evidence suggested a potential correlation between BMI and the efficacy of immune checkpoint inhibitors in cancer patients. This study aimed to evaluate the prognostic value of the body mass index (BMI) in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients treat with pembrolizumab. Methods The current retrospective cohort study enrolled 49 R/M HNSCC patients underwent at least one cycle of pembrolizumab as second‐line treatment from June 2018 to October 2020. Survival analysis of immunotherapy prognosis and risk factor analysis of age, gender, BMI, ECOG‐PS, CPS, rT‐stage, tumor site, and tube feeding. Results Among the 49 patients, the BMI at the time of immunotherapy ranged from 14.5 to 32.0 kg/m 2 . The Kaplan–Meier analysis showed that the BMI was significantly correlated with overall survival time (OS, p = 0.0007) and progression‐free survival time (PFS, p = 0.0012). BMI, gender, prior treatment, serum albumin level, ECOG‐PS, CPS and rT‐stage were analyzed in multivariate Cox regression model analysis after adjusted for potential confounding clinical variables. Patients with underweight (OS:HR = 6.862, 95% CI:1.566–30.064, p = 0.011; PFS:HR = 5.672, 95% CI:1.364–23.586, p = 0.017);ECOG≥2 (OS:HR = 0.250, 95% CI:0.086–0.731, p = 0.011;PFS:HR = 0.284, 95% CI:0.101–0.805, p = 0.018); CPS <1(OS: HR = 4.34, 95% CI:1.271–15.464, p = 0.019; PFS:HR = 3.859, 95% CI:1.180–12.618, p = 0.025) and rT4‐stage(OS:HR = 4.380, 95% CI:1.452–13.209, p = 0.009;PFS: HR = 3.799, 95% CI:1.240–11.638, p = 0.019) suffered higher risk of mortality. Conclusions The BMI at the time of clinical diagnosis was showed to be an independent predictive factor for R/M HNSCC patients receiving pembrolizumab. Compared with normal weight patients, underweight patients have worse clinical prognosis.

The Geriatric Nutritional Risk Index (GNRI) as a Prognostic Biomarker for Immune Checkpoint Inhibitor Response in Recurrent and/or Metastatic Head and Neck Cancer

“…In line with our results, a cross-cancer study by Johannet et al revealed that a BMI < 18.5 had no influence on PFS and OS [ 26 ]. In contrast, Zhang et al showed that low BMI was an independent marker for a worse clinical prognosis in R/M HNSCC patients receiving pembrolizumab [ 27 ]. These results suggest that the BMI may not be optimal for defining malnutrition in cancer patients receiving ICI [ 17 ].…”

“…Moreover, albumin decrease has been shown to be associated with rapid clearance of pembrolizumab in advanced cancer [ 31 ]. Second, the GNRI incorporates ideal weight into its calculation, which better resembles dynamic changes in chronic diseases such as tumor cachexia [ 26 , 27 , 32 ]. For example, Johannet et al showed that malnutrition, defined as weight loss six months prior to treatment, had a negative impact on immunotherapy response in non-small cell lung cancer, while baseline BMI did not [ 26 ].…”

Increased adipose tissue is associated with improved overall survival, independent of skeletal muscle mass in non‐small cell lung cancer

“…Obesity has been proved to be associated with the development of many chronic disease such as cardiovascular disease, type 2 diabetes, non‐alcoholic fatty liver disease, nephropathy and retinopathy 21–23 . In contrast, obese patients have also been reported to show better clinical prognosis in various cancers than their underweight counterparts 24–26 . This phenomenon is known as the obesity paradox.…”

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 .…”