Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan.
Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
Lung Cancer. 2020 Jan;139:140-145. doi: 10.1016/j.lungcan.2019.11.011. Epub 2019 Nov 18.
Body mass index (BMI) is reported to be associated with the efficacy of immune checkpoint inhibitors (ICIs) in solid tumors such as melanomas. However, it remains unclear whether such a relationship exists in non-small cell lung cancer (NSCLC) treated with programmed cell death protein 1 (PD-1)/ programmed death-ligand 1(PD-L1) inhibitors. The purpose of this study was to investigate the relationship between BMI and the efficacy of ICI treatment in patients with advanced NSCLC.
The medical records of NSCLC patients who received PD-1/PD-L1 antibody monotherapy at nine institutions between December 2015 and May 2018 were reviewed retrospectively. The effect of BMI was investigated in two cohorts. Cohort 1 included patients with NSCLCs with high PD-L1 expression (≥ 50 %) treated with pembrolizumab as first-line therapy, and cohort 2 included patients with NSCLCs treated with nivolumab/pembrolizumab/atezolizumab as second- or later-line treatment.
A total of 513 from nine institutions were analyzed (84 in cohort 1, 429 in cohort 2). Using a BMI cut-off value of 22 kg/m2, which is an ideal BMI in our country (high BMI:22.0 and low BMI:22.0), there was no significant difference in the PFS or OS between the high and low BMI patients in cohort 1. However, in cohort 2, survival was significantly longer in patients with a high versus low BMI (PFS: 3.7 vs. 2.8 months, p = 0.036; OS: 15.4 vs. 13.5 months, p = 0.021).
BMI was significantly associated with the efficacy of ICIs in patients with NSCLC treated with second- or later-line PD-1/PD-L1 inhibitors in our cohort.
体重指数（BMI）与黑色素瘤等实体瘤中免疫检查点抑制剂（ICI）的疗效相关。然而，在接受程序性细胞死亡蛋白 1（PD-1）/程序性死亡配体 1（PD-L1）抑制剂治疗的非小细胞肺癌（NSCLC）患者中，这种关系是否存在尚不清楚。本研究旨在探讨 BMI 与晚期 NSCLC 患者接受 ICI 治疗疗效的关系。
回顾性分析了 2015 年 12 月至 2018 年 5 月 9 家机构接受 PD-1/PD-L1 抗体单药治疗的 NSCLC 患者的病历。在两个队列中研究了 BMI 的影响。队列 1 包括接受帕博利珠单抗作为一线治疗的高 PD-L1 表达（≥50%）NSCLC 患者，队列 2 包括接受纳武利尤单抗/帕博利珠单抗/阿替利珠单抗二线或二线以上治疗的 NSCLC 患者。
共分析了 9 家机构的 513 例患者（队列 1 84 例，队列 2 429 例）。使用我国理想 BMI（高 BMI：22.0，低 BMI：22.0）的 BMI 截断值 22kg/m2，在队列 1 中，高 BMI 和低 BMI 患者的 PFS 或 OS 无显著差异。然而，在队列 2 中，高 BMI 患者的生存时间明显长于低 BMI 患者（PFS：3.7 与 2.8 个月，p=0.036；OS：15.4 与 13.5 个月，p=0.021）。
在本队列中，BMI 与接受二线或二线以上 PD-1/PD-L1 抑制剂治疗的 NSCLC 患者的 ICI 疗效显著相关。
