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. 2021 Nov 18;13(22):5772.
doi: 10.3390/cancers13225772.

Nutritional Status as a Predictive Biomarker for Immunotherapy Outcomes in Advanced Head and Neck Cancer

Meytal Guller  1   2 , Matthew Herberg  1   2 , Neha Amin  1   2 , Hosam Alkhatib  1 , Christopher Maroun  1   2 , Evan Wu  3 , Hailey Allen  1   2 , Ying Zheng  2 , Christine Gourin  1 , Peter Vosler  1 , Marietta Tan  1 , Wayne Koch  1 , David Eisele  1 , Tanguy Seiwert  2   3 , Carole Fakhry  1   3 , Drew Pardoll  2   3 , Gangcai Zhu  1   2 , Rajarsi Mandal  1   2
Affiliations

Nutritional Status as a Predictive Biomarker for Immunotherapy Outcomes in Advanced Head and Neck Cancer

Meytal Guller et al. Cancers (Basel). .

Abstract

The association between pretreatment nutritional status and immunotherapy response in patients with advanced head and neck cancer is unclear. We retrospectively analyzed a cohort of 99 patients who underwent treatment with anti-PD-1 or anti-CTLA-4 antibodies (or both) for stage IV HNSCC between 2014 and 2020 at the Johns Hopkins Hospital. Patient demographics and clinical characteristics were retrieved from electronic medical records. Baseline prognostic nutritional index (PNI) scores and pretreatment body mass index (BMI) trends were calculated. Associations between PNI and BMI were correlated with overall survival (OS), progression-free survival (PFS), and immunotherapy response. In univariate analysis, there was a significant correlation between OS and PFS with baseline PNI (OS: HR: 0.464; 95% CI: 0.265-0.814; PFS: p = 0.007 and HR: 0.525; 95% CI: 0.341-0.808; p = 0.003). Poor OS was also associated with a greater decrease in pretreatment BMI trend (HR: 0.42; 95% CI: 0.229-0.77; p = 0.005). In multivariate analysis, baseline PNI but not BMI trend was significantly associated with OS and PFS (OS: log (HR) = -0.79, CI: -1.6, -0.03, p = 0.041; PFS: log (HR) = -0.78, CI: -1.4, -0.18, p = 0.011). In conclusion, poor pretreatment nutritional status is associated with negative post-immunotherapy outcomes.

Keywords: body mass index; head and neck cancer; immunotherapy; nutritional status; oncology; prognostic nutritional index.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curves displaying (a,b) OS and PFS according to baseline PNI group; (c,d) OS and PFS by pretreatment BMI trend; aHR—adjusted hazard ratio, calculated from a Cox model controlling for age, gender, HPV status, primary site, TNM, and pretreatment BMI trend or baseline PNI group.
Figure 2
Figure 2
TMB and PD-L1 correlation analysis stratified by (a,b) pretreatment BMI trend and (c,d) baseline PNI group.
Figure 3
Figure 3
Percentages of immunotherapy responses in patients with (a) low vs. normal baseline prognostic nutritional index (PNI) and (b) pretreatment BMI trend decrease ≥2% vs. <2%. CR—complete response; PR—partial response; SD—stable disease; PD—progressive disease.
See this image and copyright information in PMC

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