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Observational Study
. 2020 Mar:128:17-26.
doi: 10.1016/j.ejca.2019.12.031. Epub 2020 Mar 5.

Another side of the association between body mass index (BMI) and clinical outcomes of cancer patients receiving programmed cell death protein-1 (PD-1)/ Programmed cell death-ligand 1 (PD-L1) checkpoint inhibitors: A multicentre analysis of immune-related adverse events

Alessio Cortellini  1 , Melissa Bersanelli  2 , Daniele Santini  3 , Sebastiano Buti  4 , Marcello Tiseo  2 , Katia Cannita  5 , Fabiana Perrone  4 , Raffaele Giusti  6 , Michele De Tursi  7 , Federica Zoratto  8 , Riccardo Marconcini  9 , Marco Russano  3 , Tea Zeppola  3 , Cecilia Anesi  3 , Marco Filetti  6 , Paolo Marchetti  10 , Andrea Botticelli  11 , Alain Gelibter  12 , Federica De Galitiis  13 , Maria Giuseppa Vitale  14 , Francesca Rastelli  15 , Marianna Tudini  16 , Rosa Rita Silva  16 , Francesco Atzori  17 , Rita Chiari  18 , Biagio Ricciuti  19 , Andrea De Giglio  19 , Maria Rita Migliorino  20 , Domenico Mallardo  21 , Vito Vanella  21 , Claudia Mosillo  22 , Sergio Bracarda  22 , Silvia Rinaldi  23 , Rossana Berardi  23 , Clara Natoli  7 , Corrado Ficorella  24 , Giampiero Porzio  24 , Paolo A Ascierto  21
Affiliations
Observational Study

Another side of the association between body mass index (BMI) and clinical outcomes of cancer patients receiving programmed cell death protein-1 (PD-1)/ Programmed cell death-ligand 1 (PD-L1) checkpoint inhibitors: A multicentre analysis of immune-related adverse events

Alessio Cortellini et al. Eur J Cancer. 2020 Mar.

Abstract

Background: Several studies have found an association between higher body mass index (BMI) and improved clinical outcomes in cancer patients receiving programmed cell death protein-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) checkpoint inhibitors. In a previous study, we found that overweight/obese patients were significantly more likely to experience any grade immune-related adverse events (irAEs) compared to non-overweight patients.

Patients and methods: We conducted a 'real-life', multi centre, retrospective observational study aimed at comparing the incidence of irAEs among cancer patients treated with PD-1/PD-L1 inhibitors according to baseline BMI.

Results: One thousand and seventy advanced cancer patients were evaluated. The median age was 68 years (range: 21-92), male/female ratio was 724/346. Primary tumours were: non-small-cell lung carcinoma (NSCLC) (653 patients), melanoma (233 patients), renal cell carcinoma (RCC) (152 patients) and others (29 patients). Median BMI was 25 (13.6-46.6); according to World Health Organisation (WHO) classification, 44 patients (4.1%) were defined as underweight, 480 patients (44.9%) as having a normal weight, 416 patients (38.9%) as overweight and 130 patients (12.1%) as obese. Higher BMI was significantly related to higher occurrence of any grade immune-related adverse events [irAEs] (p < 0.0001), G3/G4 irAEs (p < 0.0001) and irAEs leading to discontinuation (LTD) (p < 0.0001). Overweight and obesity were confirmed predictors for irAEs of any grade at both univariate and multivariate analysis. The adjusted odds ratios (ORs) (compared to normal-weight) were 10.6; 95% confidence interval (95%CI): 7.5-14.9 for overweight, and 16.6 (95%CI: 10.3-26.7) for obese patients. Obesity was the only factor significantly related to a higher incidence of G3/G4 irAEs (OR = 11.9 [95%CI: 6.4-22.3], p < 0.0001) and LTD irAEs (OR = 8.8 [95%CI: 4.3-18.2], p < 0.0001). Overweight and obese patients experienced a significantly higher occurrence of cutaneous, endocrine, gastro-intestinal (GI), hepatic and 'others' irAEs, compared to normal-weight patients. Only obese patients experienced a significantly higher occurrence of pulmonary and rheumatic irAEs, compared to normal-weight patients.

Conclusions: Considering the previously evidenced association between higher BMI and better outcome, the current finding about the relationship between BMI and irAEs occurrence can contribute to consideration of these findings as the upside of the downside, which underlies an 'immunogenic phenotype'.

Keywords: BMI; Cancer; Checkpoint inhibitors; Immune-related adverse events; Immunotherapy; Obesity; Overweight; PD-1/PD-L1.

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Conflict of interest statement

Declaration of competing interest Dr Alessio Cortellini received grants as speaker by MSD and Astra-Zeneca, grant consultancies by MSD, BMS, Roche, Novartis, Istituto Gentili, Astellas and Ipsen; Prof Clara Natoli received travel grants/personal fees from Pfizer, EISAI, Novartis, MSD, BMS and Astra-Zeneca; Dr Maria G Vitale received grant as consultant for advisory role, travel and speaker fees by BMS, Ipsen, Novartis and Pfizer, Jansen, Astellas and Pierre Fabre; Dr Raffaele Giusti received honoraria for lectures, consultation or advisory board participation from Kiowakirin, Angelini, Bristol-Myers Squibb, Boehringer-Ingelheim, MSD, Roche and Astra-Zeneca; Dr Melissa Bersanelli received research funding by Sanofi Genzyme, BMS, MSD, AstraZeneca, Seqirus, Roche, Novartis, Pfizer; honoraria as scientific speaker and advisory board consultant for BMS, Novartis, Pfizer. All other authors declared no competing interests.

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