Impact of Body Mass Index (BMI) on Survival Outcomes in Patients With Cancer Treated With Immune Checkpoint Inhibitors (ICPI): A Systematic Review and Meta Analysis

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

Journal of Clinical Oncology

Abstract

Background: With the increased adoption of ICPI in treating various cancers, there is active exploration of individual-level factors that could predict treatment responses. A high-body mass index (BMI) induces a chronic inflammatory state and could drive T-cell dysfunction through high leptin levels, which may confer better outcomes with ICPI usage. However, there are conflicting outcomes in different studies. We performed this systematic review and meta-analysis to evaluate survival outcomes with ICPI in patients with BMI ≥25 vs <25 Kg/m2. Methods: A comprehensive search was conducted across PubMed, Embase, Scopus, and web of science databases. The original studies evaluating response [overall survival (OS) and progression free survival (PFS)], to ICPI-based therapies among adult cancer patients, stratified by BMI groups (high, BMI ≥25Kg/m2 or low, BMI <25Kg/m2), were included. RevMan version 5.4.1 was used for statistical analysis. A random effect model with inverse variance as the statistical method was used for hazard ratio (HR) and 95% confidence interval (CI). Results: Of 1215 identified studies, 22 observational studies, comprising 5859 patients (60.3% males) met the inclusion criteria. ECOG performance score was reported as 0-1 for 40.3% patients, and ≥2 for 7.1% patients. In 12-studies only PD-1 and/or PD-L1 inhibitors were administered, but no CTLA-4 inhibitor. Most frequently reported cancers were non-small cell cancer of lung (40.9%), melanoma (36.6%), and renal cell cancer (31.8%) in advanced/metastatic stages. Higher BMI, compared to low BMI, favored significant improvement in PFS [HR 0.86; 95% CI (0.76, 0.99), P= 0.03, I2 47%], and OS [ HR 0.73; 95% CI (0.62, 0.85), P< 0.0001, I2 53%] with any ICPI-based regimens. Similar findings were noted for patients treated with PD-1/PDL1 inhibitors [Table]. Conclusions: This study contributes to the evidence that BMI of 25 kg/m2 or higher exerts a beneficial impact on PFS and OS among cancer patients treated with ICPI. The favorable impact underscores the significance of considering BMI as a potential prognostic factor in ICPI therapy. However, the precise underlying mechanisms responsible for this observation warrant further investigation to deepen our understanding and potentially optimize therapeutic strategies in this patient population.

Volume

42

Issue

16 Suppl

First Page

2624

Comments

American Society of Clinical Oncology Annual Meeting, ASCO 2024, May 31 - June 4, 2024, Chicago, IL

DOI

10.1200/JCO.2024.42.16_suppl.2624

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