Patients with non-small cell lung cancer who have a high body mass index (BMI) have improved survival outcomes when they receive immune checkpoint inhibitor therapy, according to study results published in JAMA Oncology.
The findings add to the growing evidence of a so-called obesity paradox in patients with cancer, in which a high BMI is linked to an increased incidence of some malignancies but may offer protection from others, the researchers noted.
Researchers examined data from four clinical trials, known as OAK, POPLAR, BIRCH and FIR, in which participants were treated with Tecentriq (atezolizumab), a PD-L1 inhibitor, or docetaxel, a chemotherapy. The final analysis included 1,434 patients who received Tecentriq and 890 treated with docetaxel.
Nearly half (49%) were of normal weight, 34% were over- weight and 7% were obese. BMI, calculated by weight in kilo- grams divided by height in meters squared, was categorized
by the World Health Organization criteria: underweight (less than 18.5), normal weight (18.5-24.9), overweight (25-29.9) and obese (30 or higher). Many obese patients were white men who had previously smoked. The median age was 64 years.
When treated with Tecentriq, obese and overweight patients had an improved overall survival compared with those of normal BMI. In addition, patients considered overweight or obese had a greater survival advantage associated with PD-L1- positive tumors compared with PD-L1-negative tumors.
“This is an interesting outcome, and it raises the potential to investigate further with other cancers and other anticancer drugs,” lead investigator Dr. Ganessan Kichenadasse, a medical oncology researcher at Flinders Centre for Innovation in Cancer in Adelaide, Australia, said in a statement. “Our study provides new evidence to support the hypothesis that high BMI and obesity may be associated with response to immunotherapy.”