Association between Body Mass Index and Immune-Related Adverse Events (irAEs) among Advanced-Stage Cancer Patients Receiving Immune Checkpoint Inhibitors: A Pan-Cancer Analysis
by
, , , , and
Dongyu Zhang
1,2,†, 
Neil J. Shah
3,†
,
Michael Cook
4,
Matthew Blackburn
4,
Michael T. Serzan
4,
Shailesh Advani
5,6,
Arnold L. Potosky
7,
Subha Madhavan
7,8,
Anas Belouali
7,8,
Michael B. Atkins
5,7,* and
Dejana Braithwaite
1,2,9,* 
1
Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
2
University of Florida Health Cancer Center, Gainesville, FL 32610, USA
3
Department of Medicine, Solid Tumor Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
4
Department of Medicine, Division of Hematology/Oncology MedStar Georgetown University Hospital, Washington, DC 20007, USA
5
Department of Oncology, School of Medicine, Georgetown University, Washington, DC 20007, USA
6
Transplant Education Research Center, Terasaki Institute of Biomedical Innovation, Los Angeles, CA 90024, USA
7
Georgetown Lombardi Comprehensive Cancer Center, Washington, DC 20057, USA
8
Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC 20007, USA
9
Department of Surgery, University of Florida, Gainesville, FL 32610, USA
*
Authors to whom correspondence should be addressed.
†
These authors have contributed equally to this work as co-first authors.
Cancers 2021, 13(23), 6109; https://doi.org/10.3390/cancers13236109
Submission received: 24 October 2021
/
Revised: 29 November 2021
/
Accepted: 2 December 2021
/
Published: 3 December 2021
/
Corrected: 19 September 2022
(This article belongs to the Special Issue Cancer Immunotherapy and Immune-Related Adverse Events)
Simple Summary
Currently, clinical studies exploring the impact of high body fat on toxicities after receiving immune checkpoint inhibitors (ICIs) among cancer patients are limited. Here, we analyze data from a health care system serving the mid-Atlantic geographic region to assess how body fat can affect the development of toxicities of ICIs. In our study, body mass index (BMI) was used as the measure of body fat, and the results suggested that cancer patients with a high BMI were more likely to have toxicities after receiving ICIs. Our study suggests that symptom management should be incorporated in the cancer care continuum of patients who receive ICIs, especially those with high BMI. In clinical settings, oncologists should inform cancer patients receiving ICIs with high BMI that their risk of post-treatment toxicities can be higher compared to their counterparts with lower BMI.
Abstract
Evidence regarding the association between body mass index (BMI) and immune-related adverse events (irAEs) among cancer patients receiving immune checkpoint inhibitors (ICIs) is limited. Here, we use cross-sectional hospital-based data to explore their relationship. Pre-treatment BMI was treated as an ordinal variable (<25, 25 to ≤30, ≥30 kg/m2). The outcome of interest was irAEs after ICI initiation. A multivariable logistic regression model estimated the adjusted odds ratio (aOR) and 95% confidence interval (CI) of BMI. A total of 684 patients with stage III or IV cancer were included in the study (lung: 269, melanoma: 204, other: 211). The mean age at the first dose of ICI was 64.1 years (SD = 13.5), 394 patients (57.6%) were male, and over one-third (N = 260, 38.0%) were non-White. Overall, 52.9% of patients had BMI ≥ 25 kg/m2 (25 to ≤30: 217, ≥30: 145) and 288 (42.1%) had irAEs after ICI treatment. Patients with higher BMI tended to have a higher rate of irAEs (<25: 35.7%, 25 to ≤30: 47.0%, ≥30: 49.0%). The multivariable logistic regression yielded consistent results (BMI ≥ 30 vs. BMI < 25: aOR = 1.47, 95% CI = 0.96–2.23; 25 ≤ BMI < 30 vs. BMI < 25: aOR = 1.46, 95% CI = 1.02–2.11, p-trend = 0.04). In conclusion, among patients with advanced cancer receiving ICIs, the rate of irAEs appears to be higher among those with higher BMI.
