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Adiposity may predict survival in patients with advanced stage cancer treated with immunotherapy in phase 1 clinical trials.

  • Martini, Dylan J1, 2
  • Kline, Meredith R1, 2
  • Liu, Yuan3
  • Shabto, Julie M1, 2
  • Williams, Milton A1, 2
  • Khan, Amir Ishaq1, 2
  • Lewis, Colleen2
  • Collins, Hannah2
  • Akce, Mehmet1, 2
  • Kissick, Haydn T2, 4
  • Carthon, Bradley C1, 2
  • Shaib, Walid L1, 2
  • Alese, Olatunji B1, 2
  • Pillai, Rathi N1, 2
  • Steuer, Conor E1, 2
  • Wu, Christina S1, 2
  • Lawson, David H1, 2
  • Kudchadkar, Ragini R1, 2
  • El-Rayes, Bassel F1, 2
  • Ramalingam, Suresh S1, 2
  • And 4 more
  • 1 Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia. , (Georgia)
  • 2 Winship Cancer Institute of Emory University, Atlanta, Georgia. , (Georgia)
  • 3 Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia. , (Georgia)
  • 4 Department of Urology, Emory University School of Medicine, Atlanta, Georgia. , (Georgia)
  • 5 Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, Georgia. , (Georgia)
Published Article
Wiley (John Wiley & Sons)
Publication Date
Feb 01, 2020
DOI: 10.1002/cncr.32576
PMID: 31648379


Body mass index (BMI) is used to define obesity, but it is an imperfect measure of body composition. In the current study, the authors explored the association between types of fat and survival in patients treated with immunotherapy. A retrospective analysis of 90 patients who were treated with immunotherapy on phase 1 clinical trials at the Winship Cancer Institute in Atlanta, Georgia, from 2009 through 2017 was performed. Overall survival (OS) and progression-free survival (PFS) were used to measure clinical outcomes. Baseline BMI and radiographic images at the middle of the third lumbar vertebrae were obtained. Fat densities were calculated and converted to indices (subcutaneous fat index [SFI], intermuscular fat index [IFI], and visceral fat index [VFI]) after dividing by height in meters squared. Risk groups were created using recursive partitioning and the regression trees method for SFI and IFI, which were selected by stepwise variable selection among all fat-related variables. The Cox proportional hazards model and Kaplan-Meier method were used for the association with OS and PFS. The majority of patients (59%) were male and diagnosed with melanoma (33%) or gastrointestinal cancers (22%). The median BMI was 27.4 kg/m2 , the median SFI was 62.78, the median IFI was 4.06, and the median VFI was 40.53. Low-risk patients (those with an SFI ≥73) had a significantly longer OS (hazard ratio, 0.20; 95% CI, 0.09-0.46 [P < .001]) and PFS (hazard ratio, 0.38; 95% CI, 0.20-0.72 [P = .003]) compared with patients at intermediate risk (those with an SFI <73 and IFI <3.4) and poor risk (those with an SFI <73 and IFI ≥3.4). The Uno concordance statistics were found to be higher for fat risk groups than BMI in predicting OS (0.603 vs 0.574; P = .581) and PFS (0.602 vs 0.586; P = .71). Increased BMI, increased SFI, and decreased IFI may be associated with prolonged survival in patients with cancer who are treated with immunotherapy. Further studies are needed to elucidate the effect of adiposity on the host immune response to immunotherapy. © 2019 American Cancer Society.

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