Baseline prognostic nutritional index and changes in pretreatment body mass index associate with immunotherapy response in patients with advanced cancer

Abstract

Background: Recent research suggests that baseline body mass index (BMI) is associated with response to immunotherapy. In this study, we test the hypothesis that worsening nutritional status prior to the start of immunotherapy, rather than baseline BMI, negatively impacts immunotherapy response.

Methods: We studied 629 patients with advanced cancer who received immune checkpoint blockade at New York University. Patients had melanoma (n=268), lung cancer (n=128) or other primary malignancies (n=233). We tested the association between BMI changes prior to the start of treatment, baseline prognostic nutritional index (PNI), baseline BMI category and multiple clinical end points including best overall response (BOR), objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS).

Results: Decreasing pretreatment BMI and low PNI were associated with worse BOR (p=0.04 and p=0.0004), ORR (p=0.01 and p=0.0005), DCR (p=0.01 and p<0.0001), PFS (p=0.02 and p=0.01) and OS (p<0.001 and p<0.001). Baseline BMI category was not significantly associated with any treatment outcomes.

Conclusion: Standard of care measures of worsening nutritional status more accurately associate with immunotherapy outcomes than static measurements of BMI. Future studies should focus on determining whether optimizing pretreatment nutritional status, a modifiable variable, leads to improvement in immunotherapy response.

Keywords: immunotherapy.

Figure 1

Kaplan-Meier curves showing progression-free survival (PFS) and overall survival (OS) by pretreatment body mass index (BMI) trends. PFS in (A) patients with any vs no decrease in pretreatment BMI among all patients, (B) BMI decrease of ≥2% vs all other patients and (C) any vs no decrease in pretreatment BMI in patients who did not meet criteria for cachexia. OS in (D) patients with any vs no decrease in pretreatment BMI among all patients, (E) BMI decrease of ≥2% vs all other patients and (F) any vs no decrease in pretreatment BMI in patients who did not meet criteria for cachexia.

Figure 2

Kaplan-Meier curves showing progression-free survival (PFS) and overall survival (OS) by baseline prognostic nutritional index (PNI). PFS in (A) patients with low vs normal PNI among all patients, and (C) patients with low vs normal PNI in patients who did not meet criteria for cachexia. OS in (B) patients with low vs normal PNI among all patients, and (D) patients with low vs normal PNI in patients who did not meet criteria for cachexia.