High BMI May Be Associated With Improved Survival Following Tecentriq Therapy in NSCLC

High body mass index (BMI) may be associated with improved overall survival (OS) in Tecentriq (atezolizumab)-treated patients with advanced non—small cell lung cancer (NSCLC), according to study findings published in JAMA Oncology.

“The treatment options for NSCLC have rapidly evolved over the past two decades with the availability of chemotherapy, molecularly targeted drugs and immune checkpoint inhibitors,” the researchers wrote.

“Available predictive biomarkers for response, such as tumor mutation burden, PD-L1 expression, and microsatellite instability, are generally focused on cancer and its associated tumor-infiltrating lymphocytes,” they added. “Because the patients who receive immune checkpoint inhibitor therapies are highly heterogeneous and tumor-based biomarkers are resource-intensive and not validated, several simple clinical and demographic characteristics are also being evaluated to estimate the probability of response. One such characteristic is obesity.”

In this study, the researchers conducted a pooled analysis of four trials to examine whether BMI was associated with survival outcomes and side effects in 2,261 patients with NSCLC who were treated with Tecentriq or docetaxel.

In total, 2,110 patients had adequate data — including 1,434 patients who received Tecentriq and 676 patients who received docetaxel.

The researchers found a linear association between increasing BMI and OS in patients treated with Tecentriq. Moreover, obesity was associated with significantly improved OS in patients treated with Teentriq, but not in those who received docetaxel after adjusting for confounding variables.

They noted that this association between BMI and OS or progression-free survival (the time from treatment to disease worsening or progression) was the strongest among those with high PD-L1 expression — a protein that helps keep immune cells from attacking nonharmful cells in the body. For example, among those with the highest expression of PD-L1, those who were obese and overweight had a reduced risk of death by 64% and 31%, respectively. Similarly, their risk for disease progression was reduced by 32% in those who were obese and 28% for those who were overweight.

“We believe we have identified for the first time that there may be a nearly linear relationship between BMI and OS with atezolizumab therapy when normal, overweight and obese categories were compared,” the researchers wrote.

Treatment-related side effects were not associated with BMI.

“The association between obesity and cancer prognosis is complicated. Although obesity increases the risks of development of certain types of cancers, such as breast cancers, obesity protects against worse outcomes in patients with advanced cancers, such as lung cancers that are associated with wasting,” the researchers added. “…Baseline high BMI may be independently associated with improved survival with atezolizumab in patients with advanced NSCLC. Baseline BMI should therefore be considered as a stratification factor in future immune checkpoint inhibitor therapy trials.”