Abstract
Simple SummaryCurrently, clinical studies exploring the impact of high body fat on toxicities after receiving immune checkpoint inhibitors (ICIs) among cancer patients are limited. Here, we analyze data from a health care system serving the mid-Atlantic geographic region to assess how body fat can affect the development of toxicities of ICIs. In our study, body mass index (BMI) was used as the measure of body fat, and the results suggested that cancer patients with a high BMI were more likely to have toxicities after receiving ICIs. Our study suggests that symptom management should be incorporated in the cancer care continuum of patients who receive ICIs, especially those with high BMI. In clinical settings, oncologists should inform cancer patients receiving ICIs with high BMI that their risk of post-treatment toxicities can be higher compared to their counterparts with lower BMI.Evidence regarding the association between body mass index (BMI) and immune-related adverse events (irAEs) among cancer patients receiving immune checkpoint inhibitors (ICIs) is limited. Here, we use cross-sectional hospital-based data to explore their relationship. Pre-treatment BMI was treated as an ordinal variable (<25, 25 to ≤30, ≥30 kg/m2). The outcome of interest was irAEs after ICI initiation. A multivariable logistic regression model estimated the adjusted odds ratio (aOR) and 95% confidence interval (CI) of BMI. A total of 684 patients with stage III or IV cancer were included in the study (lung: 269, melanoma: 204, other: 211). The mean age at the first dose of ICI was 64.1 years (SD = 13.5), 394 patients (57.6%) were male, and over one-third (N = 260, 38.0%) were non-White. Overall, 52.9% of patients had BMI ≥ 25 kg/m2 (25 to ≤30: 217, ≥30: 145) and 288 (42.1%) had irAEs after ICI treatment. Patients with higher BMI tended to have a higher rate of irAEs (<25: 35.7%, 25 to ≤30: 47.0%, ≥30: 49.0%). The multivariable logistic regression yielded consistent results (BMI ≥ 30 vs. BMI < 25: aOR = 1.47, 95% CI = 0.96–2.23; 25 ≤ BMI < 30 vs. BMI < 25: aOR = 1.46, 95% CI = 1.02–2.11, p-trend = 0.04). In conclusion, among patients with advanced cancer receiving ICIs, the rate of irAEs appears to be higher among those with higher BMI.
Highlights
Immune checkpoint inhibitors (ICIs), such as anti-cytotoxic T lymphocyte-associated antigen 4, anti-programmed cell death 1, and anti-programmed death-ligand 1, have revolutionized the management of malignant tumors, especially those at advanced stages [1,2,3]
A total of 818 subjects treated with immune checkpoint inhibitor (ICI) were identified in the I-O database, and they were included in the analysis if they had the following characteristics: (1) had stage III or IV cancer, (2) had pre-treatment body mass index (BMI), (3) information on immune-related adverse events (irAEs) was not missing, and (4) had no missing values of other study covariates
The study population had a mean age at ICI initiation of 64.1 years (SD = 13.5); 57.6% of them were male, and 62.0% and 26.6% self-reported as White or Black, respectively
Summary
Immune checkpoint inhibitors (ICIs), such as anti-cytotoxic T lymphocyte-associated antigen 4 (anti-CTLA-4), anti-programmed cell death 1 (anti-PD-1), and anti-programmed death-ligand 1 (anti-PD-L1), have revolutionized the management of malignant tumors, especially those at advanced stages [1,2,3]. As indications for ICI therapy have expanded to treat increasing numbers of patients, there are growing concerns regarding immune-related adverse events (irAEs), including potentially severe adverse events affecting major organ function and/or quality of life [7,8,9,10]. Clinical evidence suggests that high body fat can increase the likelihood of developing treatment toxicities in cancer patients receiving systemic treatment by affecting multiple signaling pathways (e.g., inflammatory, metabolic) [16]. Improving our understanding of the impact of BMI on the safety of ICIs is important for clinical practice, in terms of identifying patient subgroups that may require additional monitoring during therapy. Extant studies evaluating the relationship between BMI and irAEs in patients with cancer receiving
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