Background

Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment, showing impressive clinical benefit in some patients with multiple types of malignancies.

Some of the studies carried out to determine which patients could benefit the most of ICI therapy have indicated that patient nutritional status may impact immune response.

The aim of our study was to explore the associations between weight variation during ICI treatment and its clinical outcomes, as overall survival (OS) and progression free survival (PFS).

Methods

We conducted a single-center retrospective cohort study with advanced cancer patients, that received at least one cycle of ICI in monotherapy at an academic center. The patients were stratified according to their changes of weight during treatment with ICI (Decreasing vs Increasing/Stable). Overall survival (OS) was defined time between start of immunotherapy and death. Proportions were analyzed using Pearson Chi Square, and time to event data with the Kaplan-Meier curves and Cox Proportional Hazards.

Results

143 patients were included with a median age 64 (IQR 54-70) years and 76.9% were male. 35 (24.5%) patients had ECOG PS 0, 95 (66.5%) 1 and 13 (9.1%) 2. Lung cancer was the most common diagnosis (49%), followed by skin (16.1%) and kidney (12.6%) cancers. Median follow-up was 36 months (IQR 48-29). Most patients (134 – 93.2%) received anti-PD-1/anti-PD-L1; 44 (30.8%) were treated at 1^st line and 87 (60.8%) at 2^nd line. The group whose weight decreased (66-46.2%) experienced shorter median OS than the group whose weight increased/remain stable (77-53.8%) [11 (95% CI, 5.43- 16.57) vs 19 (95% CI, 9.82- 28.2) months, p=0.037]. Median PFS was also shorter for the group whose weight decreased [12 (95% CI, 6.52- 17.48) vs 18 (95% CI, 10.41- 25.59) months]. However, differences in PFS were not statistically significant (p=0.05).

Multivariate analysis revealed that weight loss, ECOG PS 1 or 2, second or further line treatment significantly and independently correlated with poor overall survival.

Conclusions

We observed lower survival in patients with weight loss during ICI treatment. Weight changes could help to detect progression and long-term benefit. The multidisciplinary care of patients and regular nutritional assessment is of utmost importance.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.