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Amit Arun Kulkarni
MA07 - Clinical Questions and Potential Blood Markers for Immunotherapy (ID 125)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Immuno-oncology
- Presentations: 1
- Now Available
MA07.09 - Impact of Body Mass Index on Clinical Outcomes of Immune Checkpoint Blockers in Advanced Non-Small Cell Lung Cancer (Now Available) (ID 653)
13:30 - 15:00 | Presenting Author(s): Amit Arun Kulkarni
Studies have suggested that obesity may have a paradoxical effect on the efficacy of immune check-point blockers (ICB). Higher Body Mass Index (BMI) has been associated with favorable outcomes with ICB. There is limited data on the impact of BMI on ICB efficacy in real-world patients with advanced non-small-cell lung cancer (NSCLC). We evaluated whether BMI is associated with survival outcomes in metastatic NSCLC patients treated with ICB.Method
We identified advanced NSCLC patients treated with anti-PD1/PD-L1 at our institution between 5/2015 to 1/2019. Data regarding BMI at the beginning of ICB treatment were collected. Patients with BMI > 25 (overweight and obese) were assigned to high-BMI group and patients with BMI < 25 were assigned to low-BMI group. The primary outcome was overall survival (OS). Secondary outcomes were progression-free survival (PFS) as assessed by Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). Cox proportional hazards model were used for statistical analysis.Result
148 patients with NSCLC were eligible for inclusion. The median follow-up time was 12 months. Median age was 66 years. Majority of patients were female (52.1%), Caucasian (93%), had adenocarcinoma histology (66%), current or previous smokers (88%) and received Nivolumab (88%) in the 2nd or later line setting. The median number of treatment doses were 7. Median BMI of the patient population was 25.4 kg/m2. 64/148 (43%) of patients were in the low-BMI group (BMI < 25) and 84/148 (57%) patients were included in the high-BMI group (BMI > 25). Patients in high-BMI group had superior OS (HR=0.64, 95% CI 0.45-0.90; p=0.01) that was statistically significant. 1-year OS was 46.4% and 39.0% in the high-BMI and low-BMI group respectively. PFS was also greater in high-BMI group with a trend towards statistical significance (HR=0.73, 95% CI 0.51-1.03; p=0.07). 1-year PFS was 25.0% and 15.6% in the high-BMI and low-BMI group respectively. In multivariate analysis, OS benefit remained statistically significant after adjustment for clinical covariates (age, sex, performance status, number of previous lines of therapy, smoking status and brain metastasis).Conclusion
Our study provides independent validation of previously published results demonstrating an association of BMI with survival outcomes in NSCLC patients treated with ICB. The OS benefit in the high-BMI group is independent of classical prognostic factors. While the reasons underlying this relationship remains unknown, prospective studies are needed to confirm this association. Future clinical trials with ICB should consider stratification of patients based on BMI.
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