RCC obesity paradox holds true in ICI era
medwireNews: Researchers report an association between high BMI and improved outcomes in response to immune checkpoint inhibitors (ICIs) in patients with metastatic renal cell carcinoma (RCC).
“These findings are consistent with the obesity paradox that was previously seen during the VEGF-targeted therapy era,” they write in JAMA Oncology.
Among 735 participants of the IMDC database who had available BMI data and received PD-1 or PD-L1 inhibitors, either alone or in a combination, overall survival (OS) after a median 13.5 months was significantly improved for the 63% who had a BMI of at least 25 kg/m2 at treatment initiation than for the 37% with a lower BMI.
The respective 1-year OS rates were 79% and 66%, and the risk for death was a significant 25% lower for those with a high BMI after adjustment for factors such as IMDC risk status, age, sex, line of therapy, and type of ICI.
Patients with high versus low BMI also had a higher objective response rate (30 vs 21%) and a longer median time to treatment failure (7.4 vs 4.9 months), but “these were not statistically significant in multivariable models,” say Toni Choueiri (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) and colleagues.
They acknowledge certain limitations of the study, such as the biases inherent to retrospective analyses and the use of BMI as a surrogate marker of adiposity, and conclude: “Ultimately, further correlative work is required to explore the biological underpinnings for similar findings across other solid tumors that are treated with ICIs.”
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