Table 4. Studies describing the association of chemo and immunotherapy outcomes with various obesity measures.
| Study | Sample size | Obesity measure | Results | Comment |
|---|---|---|---|---|
| Arrieta et al., 2022 (77) | 133 | BMI | Addition of metformin to EGFR TKI therapy was associated with improved PFS (HR =0.47, 95% CI: 0.28–0.78) in patients with BMI ≥24 kg/m2 only | – |
| Baldessari et al., 2021 (78) | 44 | BMI, SMI, VSR | BMI, SMI, and VSR did not predict OS | Inflammation rather than body composition is prognostic |
| Collet et al., 2021 (72) | 272 | BMI | BMI ≥25 kg/m2 associated with longer OS (HR =0.63, 95% CI: 0.44–0.92) | – |
| Cortellini et al., 2019 (22) | 976 | BMI | Patients with BMI ≥25 kg/m2 had longer OS (HR =0.49, 95% CI: 0.38–0.64), PFS (HR =0.71, 95% CI: 0.56–0.9), and TTF (HR =0.67, 95% CI: 0.53–0.85) | – |
| Cortellini et al., 2020 (24) | 1,067 | BMI | Obese (OR =16.6, 95% CI: 10.3–26.7) and overweight patients (OR =10.6, 95% CI: 7.5–14.9) experienced more immune related adverse events | Higher BMI linearly correlated with higher grade immune related adverse events and adverse events leading to discontinuation |
| Cortellini et al., 2020 (23) | 1,388 | BMI | Obesity is associated with improved ORR (OR =1.61, 95% CI: 1.04–2.5), PFS (HR =0.61, 95% CI: 0.45–0.82) and OS (HR =0.7, 95% CI: 0.49–0.99) |
Obesity is associated with improved treatment response rate and survival in patients receiving immunotherapy, but not among patients treated with chemotherapy |
| Cortellini et al., 2022 (73) | 853 | BMI | No association between first line chemoimmunotherapy and baseline BMI | – |
| Degens et al., 2019 (79) | 111 | Radiation attenuation†, skeletal muscle mass, SAT, VAT, weight loss | Loss of skeletal muscle mass associated with poor OS (HR =0.949, 95% CI: 0.915–0.985) | Loss of muscle mass correlated with radiation attenuation (P=0.015), SAT loss (P<0.001), VAT loss (P=0.029), and weight loss (P<0.001) |
| Degens et al., 2021 (80) | 106 | Skeletal muscle mass, SAT, VAT, weight loss | Weight loss >2% during treatment associated with worse OS (HR =2.39, 95% CI: 1.51–3.79) | – |
| Dragomir et al., 2021 (81) | 80 | BMI | Decreased PFS with decrease in BMI (OR =0.96, 95% CI: 0.96–1.91) and NLR ≥3 (OR =1.1, 95% CI: 0.38–3.12) | – |
| Gelibter et al., 2020 (69) | 976 | BMI | Prolonged OS (HR =0.33, 95% CI: 0.28–0.41), PFS (HR =0.46, 95% CI: 0.39–0.54), and TTF (HR =0.51, 95% CI: 0.44–0.6) in overweight/obese patients | – |
| Hirsch et al., 2020 (82) | 92 | BMI, SMI | Sarcopenia was independently associated with increased risk of experiencing irALT (OR =3.84, 95% CI: 1.02–14.46) | BMI was not associated with increased risk of irALT |
| Imai et al., 2022 (74) | 99 | BMI | BMI ≥22.1 kg/m2 was associated with longer OS (P=0.002) | – |
| Kichenadasse et al., 2020 (21) | 2,110 | BMI | Improved OS in obese (HR =0.69, 95% CI: 0.54–0.87) and overweight (HR =0.8, 95% CI: 0.67–0.96) patients | Association strengthened for PD-L1 positive tumors. No association for docetaxel treated patients |
| Liu et al., 2022 (83) | 66 | BMI | High BMI associated with improved PFS (P=0.04) on univariate analysis only | – |
| Magri et al., 2019 (84) | 46 | BMI, weight loss | Post-diagnosis weight loss of >5% associated with worse OS (HR =2.85, P<0.01) | BMI not associated with OS |
| Minami et al., 2019 (67) | 167 | BMI, IMAC, PMI, VSR | Pre-treatment BMI <18.5 kg/m2 associated with shorter OS (HR =1.7, 95% CI: 1.03–2.81) and shorter PFS (HR =1.72, 95% CI: 1.11–2,67) | Neither pretreatment sarcopenia nor visceral obesity was associated with survival prognosis of NSCLC patients treated with EGFR-TKI monotherapy |
| Minami et al., 2020 (85) | 74 | BMI, IMAC, PMI, VFA, VSR | Low IMAC associated with longer OS (HR =0.43, 95% CI: 0.18–0.998) | PMI, VSR and VFA not associated with OS and PFS on NSCLC patients on ICI monotherapy |
| Nie et al., 2021 (75) | 3,768 | BMI | Improved OS (HR =0.81, 95% CI: 0.71–0.92) overweight/obese NSCLC patients | – |
| Nishioka et al., 2022 (86) | 74 | BMI, LSMI, TATI | Decrease in TATI associated with increased overall response rate (P<0.05) and longer PFS (P=0.03) in non-cachexic patients | No difference in ORR and PFS among cachexic patients |
| Popinat et al., 2019 (87) | 55 | FBM, LBM, MBM, SCFM, VFM | Increase in SCFM associated with poor OS (HR =0.75) | – |
| Sakin et al., 2021 (76) | 233 | BMI | BMI ≥25 kg/m2 associated with longer OS (HR =0.41, 95% CI: 0.18–0.91) | – |
| Tateishi et al., 2022 (88) | 324 | BMI | No difference in ORR, OS, and PFS observed between overweight and non-overweight patients | – |
| Wang et al., 2021 (71) | 61 | BMI | Improved OS (HR =0.15, 95% CI: 0.07–0.32) and PFS (HR =0.23, 95% CI: 0.11–0.48) in patients with BMI >23.2 kg/m2 | Linear positive correlation between pre-treatment BMI and number of post-treatment serum immune cells (r2>0.7) |
†, radiation attenuation is a sign of increase in intramuscular adipose tissue. BMI, body mass index; EGFR TKI, epithelial growth factor receptor tyrosine kinase inhibitor; PFS, progression free survival; HR, hazard ratio; CI, confidence interval; SMI, skeletal muscle index; VSR, visceral-to-subcutaneous ratio; OS, overall survival; TTF, time to treatment failure; OR, odds ratio; ORR, objective response rate; SAT, subcutaneous adipose tissue; VAT, visceral adipose tissue; NLR, neutrophil to lymphocyte ratio; irALT, immune-related acute limiting toxicity; PD-L1, programmed death ligand 1; IMAC, intramuscular adipose content; PMI, psoas muscle index; NSCLC, non-small cell lung cancer; VFA, visceral fat area; ICI, immune checkpoint inhibitor; LSMI, lumbar skeletal muscle index; TATI, total adipose tissue index; FBM, fat body mass; LBM, lean body mass; MBM, muscle body mass; SCFM, subcutaneous fat mass; VFM, visceral fat mass.