NSCLC: high BMI offers survival boost with atezolizumab

  • Kichenadasse G & al.
  • JAMA Oncol
  • 26 Dec 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • High baseline BMI is associated with better OS and PFS in patients with advanced NSCLC treated with atezolizumab, but not those treated with docetaxel.
  • The association was strongest in patients positive for programmed cell death ligand 1 (PD-L1).

Why this matters

  • Future clinical trials of immune checkpoint inhibitors in patients with advanced NSCLC should stratify for baseline BMI.

Study design

  • Pooled data from 4 clinical trials.
  • 2110 patients with advanced NSCLC received atezolizumab (n=1434) or docetaxel (n=676).
  • Funding: Cancer Council South Australia; others.

Key results

  • In the atezolizumab group, OS was significantly better in patients who were obese (HR, 0.64; 95% CI, 0.51-0.81) or overweight (HR, 0.81; 95% CI, 0.68-0.95) compared with those with normal BMI.
  • Atezolizumab-treated patients with PD-L1-positive tumors had a better survival advantage with higher BMI vs those with PD-L1-negative tumors:
    • With overweight: HR, 0.73 (95% CI, 0.58-0.91).
    • With obesity: HR, 0.48 (95% CI, 0.34-0.66).
  • PFS was significantly better with high BMI and atezolizumab:
    • Obese+overweight: HR, 0.88 (P=.03).
  • PFS was highest with high BMI and PD-L1-positive tumors:
    • With overweight: HR, 0.86.
    • With obesity: HR, 0.78 (P=.03).
  • No significant association was found between BMI and PFS or OS in patients receiving docetaxel.

Limitations

  • Retrospective study.