BMI linked to safety of checkpoint inhibitors among patients with advanced cancer
Click Here to Manage Email Alerts
High BMI appeared associated with increased risk for any-grade immune-related adverse events among a cohort of patients with advanced cancer undergoing treatment with immune checkpoint inhibitors.
The findings, published in JAMA Oncology, additionally showed an association between obesity and high-grade immune-related adverse events among women only.
Rationale and methods
“Increased survival with immune checkpoint inhibitors has been reported for patients with obesity vs. those with a normal BMI," Jennifer McQuade, MD, assistant professor of melanoma medical oncology at The University of Texas MD Anderson Cancer Center, and colleagues wrote. “However, the association of obesity with the safety of immune checkpoint inhibitors warrants study.”
Researchers used data from 14 clinical trials conducted between Feb. 9, 2012, and May 21, 2015, that included 3,772 patients (69% men; median age, 61 years) with advanced cancers to investigate the association between BMI and immune-related adverse events from checkpoint inhibitor therapy.
Patients received either 3 mg/kg nivolumab (Opdivo, Bristol Myers Squibb; n = 2,746); 3 mg/kg nivolumab plus 1 mg/kg ipilimumab (Yervoy, Bristol Myers Squibb; n = 713) or 1 mg/kg nivolumab plus 3 mg/kg ipilimumab (n = 313). Researchers categorized BMI as normal weight or underweight (< 25), overweight (25 to < 30) or obese ( 30).
Main outcomes included incidence of any-grade and grade 3 or grade 4 immune-related adverse events among patients with obesity vs. normal weight or underweight BMI in the overall cohort, as well as in subgroups based on patient and tumor characteristics.
Findings
Among patients treated with nivolumab alone, those categorized as obese (n = 543) experienced the highest incidence of any-grade immune-related adverse events compared with those with normal weight or underweight BMI (n = 1,266; OR = 1.71; 95% CI, 1.38-2.11).
Incidence of grade 3 or grade 4 immune-related adverse events appeared similar between patients with obesity and those with normal weight or underweight (OR = 1.21; 95% CI, 0.92-1.61). However, the risk for grade 3 or grade 4 immune-related adverse events appeared higher among women with obesity vs. those with normal weight or underweight BMI (OR = 1.73; 95% CI, 1.07-2.79).
Incidence of immune-related adverse events appeared consistent across all three BMI groups among those treated with nivolumab plus ipilimumab.
Limitations of the study included the retrospective pooled-data design, the use of descriptive univariable analyses and the heterogeneity of the studies evaluated, researchers noted.
Implications
The findings may inform the monitoring of patients at high risk for developing immune-related adverse events, according to McQuade and colleagues.
“The results of this analysis highlight the importance of BMI as a clinical covariate for patients receiving immune checkpoint inhibitors and support further evaluation in prospective studies of associations between body composition and patient outcomes during treatment with immune checkpoint inhibitors,” they wrote.
Collapse
Click Here to Manage Email Alerts