The association between body mass index and efficacy of pembrolizumab as second-line therapy in patients with recurrent/metastatic head and neck squamous cell carcinoma.

Abstract

Recent evidence suggested a potential correlation between BMI and the efficacy of immune checkpoint inhibitors in cancer patients. This study aimed to evaluate the prognostic value of the body mass index (BMI) in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients treat with pembrolizumab. The current retrospective cohort study enrolled 49 R/M HNSCC patients underwent at least one cycle of pembrolizumab as second-line treatment from June 2018 to October 2020. Survival analysis of immunotherapy prognosis and risk factor analysis of age, gender, BMI, ECOG-PS, CPS, rT-stage, tumor site, and tube feeding. Among the 49 patients, the BMI at the time of immunotherapy ranged from 14.5 to 32.0kg/m2 . The Kaplan-Meier analysis showed that the BMI was significantly correlated with overall survival time (OS, p=0.0007) and progression-free survival time (PFS, p=0.0012). BMI, gender, prior treatment, serum albumin level, ECOG-PS, CPS and rT-stage were analyzed in multivariate Cox regression model analysis after adjusted for potential confounding clinical variables. Patients with underweight (OS:HR=6.862, 95% CI:1.566-30.064, p=0.011; PFS:HR=5.672, 95% CI:1.364-23.586, p=0.017);ECOG≥2 (OS:HR=0.250, 95% CI:0.086-0.731, p=0.011;PFS:HR=0.284, 95% CI:0.101-0.805, p=0.018); CPS <1(OS: HR=4.34, 95% CI:1.271-15.464, p=0.019; PFS:HR=3.859, 95% CI:1.180-12.618, p=0.025) and rT4-stage(OS:HR=4.380, 95% CI:1.452-13.209, p=0.009;PFS: HR=3.799, 95% CI:1.240-11.638, p=0.019) suffered higher risk of mortality. The BMI at the time of clinical diagnosis was showed to be an independent predictive factor for R/M HNSCC patients receiving pembrolizumab. Compared with normal weight patients, underweight patients have worse clinical prognosis.