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Prognostic effect of body mass index in patients with advanced NSCLC treated with chemoimmunotherapy combinations

Prognostic effect of body mass index in patients with advanced NSCLC treated with chemoimmunotherapy combinations
Prognostic effect of body mass index in patients with advanced NSCLC treated with chemoimmunotherapy combinations

Introduction: it has been recognized that increasing body mass index (BMI) is associated with improved outcome from immune checkpoint inhibitors (ICIs) in patients with various malignancies including non-small cell lung cancer (NSCLC). However, it is unclear whether baseline BMI may influence outcomes from first-line chemoimmunotherapy combinations. 

Methods: in this international multicenter study, we evaluated the association between baseline BMI, progression-free survival (PFS) and overall survival (OS) in a cohort of patients with stage IV NSCLC consecutively treated with first-line chemoimmunotherapy combinations. BMI was categorized according to WHO criteria. 


Results: among the 853 included patients, 5.3% were underweight; 46.4% were of normal weight; 33.8% were overweight; and 14.5% were obese. Overweight and obese patients were more likely aged ≥70 years (p=0.00085), never smokers (p<0.0001), with better baseline Eastern Cooperative Oncology Group - Performance Status (p=0.0127), and had lower prevalence of central nervous system (p=0.0002) and liver metastases (p=0.0395). Univariable analyses showed a significant difference in the median OS across underweight (15.5 months), normal weight (14.6 months), overweight (20.9 months), and obese (16.8 months) patients (log-rank: p=0.045, log rank test for trend: p=0.131), while no difference was found with respect to the median PFS (log-rank for trend: p=0.510). Neither OS nor PFS was significantly associated with baseline BMI on multivariable analysis. 

Conclusions: in contrast to what was observed in the context of chemotherapy-free ICI-based regimens, baseline BMI does not affect clinical outcomes from chemoimmunotherapy combinations in patients with advanced NSCLC.

immunity, lung neoplasms, metabolic networks and pathways, programmed cell death 1 receptor
Cortellini, Alessio
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Ricciuti, Biagio
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Vaz, Victor R.
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Soldato, Davide
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Alessi, Joao V.
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Dall'olio, Filippo G.
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Banna, Giuseppe L.
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Muthuramalingam, Sethupathi
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Chan, Samuel
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Majem, Margarita
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Piedra, Aida
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Lamberti, Giuseppe
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Andrini, Elisa
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Addeo, Alfredo
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Friedlaender, Alex
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Facchinetti, Francesco
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Gorriá, Teresa
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Mezquita, Laura
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Hoton, Delphine
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Valerie, Lacroix
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Nana, Frank Aboubakar
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Artingstall, James
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Comins, Charles
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Di Maio, Massimo
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Caglio, Andrea
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Cave, Judith
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McKenzie, Hayley
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D'Alessio, Antonio
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Fulgenzi, Claudia A.M.
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Besse, Benjamin
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Awad, Mark M.
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Pinato, David J.
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Cortellini, Alessio
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Ricciuti, Biagio
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Vaz, Victor R.
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Soldato, Davide
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Alessi, Joao V.
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Banna, Giuseppe L.
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Chan, Samuel
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Majem, Margarita
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Piedra, Aida
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Andrini, Elisa
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Addeo, Alfredo
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Friedlaender, Alex
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Facchinetti, Francesco
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Gorriá, Teresa
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Mezquita, Laura
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Hoton, Delphine
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Artingstall, James
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Comins, Charles
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Di Maio, Massimo
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Caglio, Andrea
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Cave, Judith
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McKenzie, Hayley
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Newsom-Davis, Thomas
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Evans, Joanne S.
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D'Alessio, Antonio
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Fulgenzi, Claudia A.M.
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Besse, Benjamin
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Awad, Mark M.
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Pinato, David J.
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Cortellini, Alessio, Ricciuti, Biagio, Vaz, Victor R., Soldato, Davide, Alessi, Joao V., Dall'olio, Filippo G., Banna, Giuseppe L., Muthuramalingam, Sethupathi, Chan, Samuel, Majem, Margarita, Piedra, Aida, Lamberti, Giuseppe, Andrini, Elisa, Addeo, Alfredo, Friedlaender, Alex, Facchinetti, Francesco, Gorriá, Teresa, Mezquita, Laura, Hoton, Delphine, Valerie, Lacroix, Nana, Frank Aboubakar, Artingstall, James, Comins, Charles, Di Maio, Massimo, Caglio, Andrea, Cave, Judith, McKenzie, Hayley, Newsom-Davis, Thomas, Evans, Joanne S., Tiseo, Marcello, D'Alessio, Antonio, Fulgenzi, Claudia A.M., Besse, Benjamin, Awad, Mark M. and Pinato, David J. (2022) Prognostic effect of body mass index in patients with advanced NSCLC treated with chemoimmunotherapy combinations. Journal for Immunotherapy of Cancer, 10 (2), [e004374]. (doi:10.1136/jitc-2021-004374).

Record type: Article

Abstract

Introduction: it has been recognized that increasing body mass index (BMI) is associated with improved outcome from immune checkpoint inhibitors (ICIs) in patients with various malignancies including non-small cell lung cancer (NSCLC). However, it is unclear whether baseline BMI may influence outcomes from first-line chemoimmunotherapy combinations. 

Methods: in this international multicenter study, we evaluated the association between baseline BMI, progression-free survival (PFS) and overall survival (OS) in a cohort of patients with stage IV NSCLC consecutively treated with first-line chemoimmunotherapy combinations. BMI was categorized according to WHO criteria. 


Results: among the 853 included patients, 5.3% were underweight; 46.4% were of normal weight; 33.8% were overweight; and 14.5% were obese. Overweight and obese patients were more likely aged ≥70 years (p=0.00085), never smokers (p<0.0001), with better baseline Eastern Cooperative Oncology Group - Performance Status (p=0.0127), and had lower prevalence of central nervous system (p=0.0002) and liver metastases (p=0.0395). Univariable analyses showed a significant difference in the median OS across underweight (15.5 months), normal weight (14.6 months), overweight (20.9 months), and obese (16.8 months) patients (log-rank: p=0.045, log rank test for trend: p=0.131), while no difference was found with respect to the median PFS (log-rank for trend: p=0.510). Neither OS nor PFS was significantly associated with baseline BMI on multivariable analysis. 

Conclusions: in contrast to what was observed in the context of chemotherapy-free ICI-based regimens, baseline BMI does not affect clinical outcomes from chemoimmunotherapy combinations in patients with advanced NSCLC.

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Accepted/In Press date: 11 January 2022
Published date: 16 February 2022
Additional Information: Funding Information: Funding This study was supported in part by the NIHR Imperial College BRC Push for Impact scheme 2019. AD’A is supported by grant funding from the European Association for the Study of the Liver (Andrew Burroughs Fellowship). BR is supported by the Society of Immunotherapy of Cancer-AstraZeneca Young Investigator Award. DJP is supported by grant funding from the Wellcome Trust Strategic Fund (PS3416) and from the Associazione Italiana per la Ricerca sul Cancro (AIRC MFAG Grant ID 25697) and acknowledges support by the NIHR Imperial Biomedical Research Centre (BRC), the Imperial Experimental Cancer Medicine Centre (ECMC) and the Imperial College Tissue Bank. AC is supported by the NIHR Imperial BRC.
Keywords: immunity, lung neoplasms, metabolic networks and pathways, programmed cell death 1 receptor

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Local EPrints ID: 456594
URI: http://eprints.soton.ac.uk/id/eprint/456594
PURE UUID: 117b3909-705e-4ad8-ab44-b9873f08c5cf

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Date deposited: 05 May 2022 16:45
Last modified: 01 Jul 2022 16:51

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Contributors

Author: Alessio Cortellini
Author: Biagio Ricciuti
Author: Victor R. Vaz
Author: Davide Soldato
Author: Joao V. Alessi
Author: Filippo G. Dall'olio
Author: Giuseppe L. Banna
Author: Sethupathi Muthuramalingam
Author: Samuel Chan
Author: Margarita Majem
Author: Aida Piedra
Author: Giuseppe Lamberti
Author: Elisa Andrini
Author: Alfredo Addeo
Author: Alex Friedlaender
Author: Francesco Facchinetti
Author: Teresa Gorriá
Author: Laura Mezquita
Author: Delphine Hoton
Author: Lacroix Valerie
Author: Frank Aboubakar Nana
Author: James Artingstall
Author: Charles Comins
Author: Massimo Di Maio
Author: Andrea Caglio
Author: Judith Cave
Author: Hayley McKenzie
Author: Thomas Newsom-Davis
Author: Joanne S. Evans
Author: Marcello Tiseo
Author: Antonio D'Alessio
Author: Claudia A.M. Fulgenzi
Author: Benjamin Besse
Author: Mark M. Awad
Author: David J. Pinato

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