The authors wrote, “The association between obesity and response to cancer treatment and survival remains unclear, with conflicting findings from various studies. The optimal choice between conventional chemotherapy and immunotherapy for first-line treatment remains uncertain in patients with obesity who potentially have an inadequate therapeutic response to immunotherapy.”
This retrospective study examined whether BMI alters the correlation of immunotherapy or conventional therapy regarding rates of overall survival in patients with aNSCLC.
The study was conducted between December 1, 2015, and January 31, 2023. The primary outcome was overall survival, and survival analysis included a 3-year follow-up period after the first-line chemotherapy.
The cohort included 31,257 patients who were aged 18 years and older diagnosed with aNSCLC and who received immunotherapy employing an immune checkpoint inhibitor (ICI) treatment or conventional chemotherapy. Among the study cohort, 12,816 patients received immune checkpoint inhibitor (ICI) therapy (average age 70.2 years, standard deviation [SD] 9.1; 80.3% men) and 18,441 patients received conventional chemotherapy (average age 70.2 years, SD 8.9; 76.7% men).
The results revealed that among patients with a BMI less than 28, ICI therapy was associated with a meaningfully lower risk of mortality (e.g., BMI of 24: hazard ratio [HR], 0.81; 95% CI, 0.75-0.87) compared with conventional chemotherapy; however, this correlation was not observed in patients with a BMI of 28 or greater (e.g., BMI 28: HR, 0.90; 95% CI, 0.81-1.00).
The authors wrote, “The findings of this retrospective cohort study suggest that BMI modifies the association of ICI therapy compared with conventional chemotherapy with overall survival in patients with aNSCLC. A lack of association between ICI therapy and improved survival in patients with aNSCLC and overweight or obesity compared with conventional chemotherapy was observed.“
The authors added that among patients who are overweight or obese, the findings imply that ICI therapy may not be the ideal first-line therapy, and the use of conventional chemotherapy should also be considered as therapy in this patient population.
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