A previous study identified an association between high body mass index (BMI) and better overall survival (OS) in mRCC patients treated with vascular endothelial growth factor-tyrosine kinase inhibitors (VEGF-TKIs) (Albiges et al JCO 2016). We assessed whether the effect of BMI on OS extended beyond VEGF-TKI to immunotherapy (IO) or VEGF/IO combination regimens.
A retrospective study was done among patients diagnosed with mRCC treated at a single institution from 2009 to 2017. Demographic and clinical variables were collected. BMI was characterized as high (≥25 kg/m2) versus low (<25 kg/m2). The Kaplan-Meier method was used to estimate the difference in OS, segregated by BMI and further by treatment type (e.g., VEGF-TKI, IO or VEGF/IO).
Among 235 patients, median age was 65 years (33-90), 73% were male, and 65% were overweight or obese (BMI ≥ 25 kg/m2). The majority of patients had undergone nephrectomy (86%). The most systemic therapy was VEGF-TKI (58%), followed by IO (17%) and VEGF/IO (25%). In patients treated with VEGF-TKI with low BMI, median OS was 25.0 months (95% CI: 18.7-31.2) versus 36.0 months (95% CI: 25.2-46.7) in patients with high BMI (P = 0.01). A similar result was found for patients treated with VEGF/IO, where median OS was 18.0 months (95% CI:10.0-25.9) for patients with low BMI versus 24.0 months (95% CI: 14.8-33.2) in patients with high BMI (P = 0.01). However, patients treated with IO with low BMI, median OS was 55.0 months (95% CI: 33.7-76.7) versus 22.9 months (95% CI: 17.7-28.1) in patients with high BMI (P = 0.33).
High BMI was associated with improved OS in patients with mRCC treated with VEGF-TKI or VEGF/IO, but the inverse trend was observed among patients receiving IO. In addition to validating previous findings associating VEGF-TKI, BMI and clinical outcome, our data highlight the need to reassess this phenomenon in the context of IO-based regimens.
Clinical trial identification
Legal entity responsible for the study
City of Hope.
Has not received any funding.
All authors have declared no conflicts of interest.