Body Mass Index May Play a Role in Lung Cancer Treatment Decisions

The body mass index of patients with non-small cell lung cancer may affect whether they should receive chemotherapy or immunotherapy.

Patients with advanced non-small cell lung cancer (NSCLC) who are overweight or obese may have better outcomes if they are initially treated with chemotherapy rather than immunotherapy, according to recent research.

The study, which was published in JAMA Network Open, collected data from 31,257 patients with advanced NSCLC — 12,816 of whom were treated with immunotherapy, while 18,441 were treated with conventional chemotherapy.

Findings showed that for patients who had a body mass index (BMI) less than 28, immunotherapy was associated with a lower risk of death compared to those who had conventional chemotherapy. Conversely, the researchers did not observe a survival benefit with immunotherapy in patients with a BMI of 28 or higher.

“The findings of this study suggest that immune checkpoint inhibitor therapy may not be the optimal first-line therapy in patients with overweight or obesity [advanced] NSCLC,” the authors wrote. “Hence, the use of conventional chemotherapy should also be considered in such patients.

Of note, according to the World Health Organization, BMIs between 25 and 29.9 are classified as being in the overweight range; 30 to 39.9 are considered in the obese range; and BMIs of 40 or above are considered severely obese.

These findings might help determine treatment strategies for patients who are overweight or obese.

“The optimal choice between conventional chemotherapy and immunotherapy for first-line therapy remains uncertain in patients with obesity. This is why this study was conducted,” study author Yasutaka Ihara, professor in the Department of Medical Statistics at Osaka Metropolitan University Graduate School of Medicine in Japan, said in an interview with CURE®. “If there is one finding that patients should know, they should know that personalized medicine is developing, tailored to each patient's constitution and other factors.”

With regard to specific immunotherapy drugs used, among the 12,816 patients who received immunotherapy, the majority (77.3%; 9,905) received Keytruda (pembrolizumab), while 12.7% (1,630) received Opdivo (nivolumab), either with or without Yervoy (ipilimumab) and 10% (1,281) received Tecentriq (atezolizumab).

A total of 28% of patients in the immunotherapy group and 35.9% of patients in the conventional chemotherapy group died within three years of receiving treatment. In both groups, the researchers observed an association between a higher BMI and lower death risk compared to those with a lower BMI.

READ MORE: Findings Link Higher BMI to Better Immunotherapy Outcomes in NSCLC

The authors wrote, “The results of this study support the preclinical findings suggesting that patients with obesity may exhibit inadequate therapeutic response to anti-PD-1 therapy…”

Looking forward, the researchers noted that more research is needed regarding the association between BMI and response or outcomes to oncologic therapies. In the meantime, Ihara mentioned that cancer treatment continues to become more personalized. As such, patients should have open discussions with their health care teams to determine the best therapies.

“Patients should discuss with health care providers how personalized treatments suit their unique diagnosis, potential benefits and risks, the need for genetic testing, costs, lifestyle preferences, and follow-up plans to ensure the best care,” he said.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.