Impact of BMI on Survival Outcomes of Immunotherapy in Solid Tumors: A Systematic Review

Abstract

Growing research has focused on obesity as a prognostic factor during therapy with immune-checkpoint inhibitors (ICIs). The role of body-mass index (BMI) in predicting response and toxicity to ICIs is not clear, as studies have shown inconsistent results and significant interpretation biases. We performed a systematic review to evaluate the relationship between BMI and survival outcomes during ICIs, with a side focus on the incidence of immune-related adverse events (irAEs). A total of 17 studies were included in this systematic review. Altogether, the current evidence does not support a clearly positive association of BMI with survival outcomes. Regarding toxicities, available studies confirm a superimposable rate of irAEs among obese and normal weight patients. Intrinsic limitations of the analyzed studies include the retrospective nature, the heterogeneity of patients' cohorts, and differences in BMI categorization for obese patients across different studies. These factors might explain the heterogeneity of available results, and the subsequent absence of a well-established role of baseline BMI on the efficacy of ICIs among cancer patients. Further prospective studies are needed, in order to clarify the role of obesity in cancer patients treated with immunotherapy.

Keywords: anti-CTLA4; anti-PD1; anti-PDL1; cancer; immunotherapy; irAEs; obesity; obesity paradox; survival.

Figure 1

Immune dysfunction related with obesity and background for increased immunotherapy activity. Abbreviations: IFN, interferon; IL, interleukin; MDSC; myeloid derived stem cell; PD-1, programmed cell death 1; PD-L1, programmed cell death ligand 1; Th, T helper; TNF, tumor necrosis factor; T reg, regulatory T cell.

Figure 2

Flow diagram of literature research and study selection.