Abstract
Immunotherapy has developed as an integral part of the treatment for lung cancer. Obesity has become a pandemic accounting for >20% of the total United States healthcare expenditure. Obesity has been shown to be associated with an increased efficacy of PD-1/PD-L1 blockade. On the other hand, cachectic patients have been shown to not respond as well to immunotherapy. In this study, we aim to assess the pretreatment nutritional status with outcomes of lung cancer patients being treated with immunotherapy. An IRB approved retrospective review of lung cancer patients receiving immunotherapy between 2014 and 2017 at the Monter Cancer Center, Northwell Health was conducted. Low nutritional status as defined by either a Body Mass Index (BMI) <18.5 and/or albumin <3.5 mg/dL prior to immunotherapy treatment. Patients were stratified by BMI: underweight (BMI<18.5), normal weight (BMI of 18.5 to <25), overweight (BMI 25 to 30) and obese (BMI >30). The groups were compared using the log-rank test. Kaplan-Meier was used for overall survival (OS) and progression free survival (PFS) and Cox regression models were used to adjust for potential confounders. A total of 116 were included in the analysis, with a median age of 70 (95% CI, 62.5 to 75.5). Patients with a low nutritional status had a median PFS of 2.2 months compared to those who did not of 5.2 months (p<0.00032). Ten (8.6%) were underweight, 44 (37.9%) were normal weight, 32 (27.6%) were overweight, and 30 (25.9%) were obese. PFS was 6.6, 6.0, and 6.9 months for patients in the underweight, normal weight, and overweight/obese groups, respectively. A total of 46 (40%) deceased within the follow up period: 3 (30%), 17 (39%), 11 (34%), and 15 (50%) respectively. BMI classification were not found to be a significant predictor of survival, after adjusting for therapy duration (p=0.44). In this single institution retrospective review, lung cancer patients receiving immunotherapy with our defined low nutritional status had a lower PFS. BMI or albumin as individual factors did not have a significant effect on PFS or OS. Additional studies are needed to validate these findings and assess the effects of nutritional status on immunotherapy.
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