Abstract 63P
Background
The role of overweight/obesity (ow/ob) and sarcopenia in cancer patients treated with immune checkpoint inhibitors (ICIs) continues to be debated. Therefore, we performed a systematic review and meta-analysis of published articles evaluating the effects of ow/ob and sarcopenia on survival and immune-related adverse events (irAEs).
Methods
According to Cochrane recommendations, systematic literature searches included all published articles in PubMed until February 2021 with key terms “obesity”, “overweight” and “sarcopenia” and ICI treatment irrespective of cancer entity and ICI used. Further selection criteria for meta-analysis included defined cut-offs for ow/ob and sarcopenia. For the random effects meta-analysis, we used Hazard Ratios (HR) for overall and progression-free survival (OS, PFS) and Odds Ratios (OR) for occurrence of irAEs.
Results
A total of 26 studies (8,034 patients) selected for ow/ob meta-analysis revealed a superior survival of ow/ob patients (PFS: HR 0.91, p = 0.15; OS: 0.73, p = 0.0002). In a subgroup analyses based on sex, only male patients benefitted from increased BMI, whereas ow/ob female patients had same survival probabilities compared to their normal weight counterparts. Ow/ob patients also had a higher risk of irAEs with grade ≥ 3 (OR 1.78, p = 0.02). In addition, 15 studies (1,428 patients) selected for sarcopenia meta-analysis showed a worse survival of sarcopenic patients (PFS: HR 1.53, p = 0.0001; OS: HR 1.6, p = 0.0005) with the same risk of developing irAEs.
Conclusions
Our meta-analysis revealed that ow/ob is a beneficial factor for PFS and OS in a mixed cohort of cancer patients undergoing ICI treatment accompanied by an increased risk of severe irAEs. The differences between ow/ob males and ow/ob females might point to sex specific adipose distribution patterns. A significant number of studies included underweight patients into control groups which led to a compromised interpretation of the data and should be addressed in future studies. Sarcopenia as an established risk factor for conventional chemotherapy and surgical oncologic interventions seems to also hold true for ICI treatment.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Ludwig-Maximilians-Universität München, Promotionsstipendium.
Disclosure
All authors have declared no conflicts of interest.