The combination of body mass index and serum creatinine levels predicts survival in patients with Hodgkin lymphoma treated with nivolumab in the CheckMate 205 study.

in Oncoimmunology by Rosaria De Filippi, Fortunato Morabito, Giovanni Tripepi, Stephen M Ansell, Sara Mele, Emanuela Morelli, Domenico Mallardo, Daniela Donnarumma, Francesco Volzone, Alev Akyol, Annarosa Cuccaro, Mariangela Saggese, Matteo Bonanni, Maria Esposito, Stefania Crisci, Pier Luigi Zinzani, Antonio Pinto

TLDR

  • The study found that patients with a lower BMI survive longer after treatment with nivolumab, and developed a way to predict treatment outcomes based on BMI and creatinine levels
  • The findings suggest that considering BMI in personalized treatment decisions for HL patients could improve outcomes

Abstract

Patients with solid tumors and a higher body mass index (BMI) experience improved survival after receiving anti-PD1 antibodies. The predictive role of BMI in Hodgkin Lymphoma (HL), the most sensitive malignancy to PD1-blockade, remains unclear. We analyzed the association between BMI and survival outcomes in patients treated with the anti-PD-1 antibody nivolumab within the CheckMate 205 study. Patients with a lower BMI (<24.03 kg/m) had a longer progression-free survival (PFS) (46.4% at three years) than those with a higher BMI (≥24.03 kg/m;19.6%;= 0.03). Combining the BMI cutoff with serum creatinine (sCr) levels generated a variable (BMCI) stratifying patients into distinct PFS risk groups. Patients with a BMCI(BMI ≥24.03 kg/m/sCr <0.7 mg/dL) displayed a threefold increased PFS risk (95% CI,1.6-5.7;< 0.001) than those with a BMCI(BMI <24.03 kg/m/sCr ≥0.7 mg/dL). In a separate analysis of pretreated patients, those with a BMCIhad a PFS risk 3.5-fold higher (95% CI,1.9-6.6;< 0.001) than patients with a BMCI. The BMCI maintained its independent significance in a multivariable model including attenuating factors and predictive biomarkers. HL patients with reduced BMI but preserved lean body mass (BMCI) exhibit a more favorable response to nivolumab. Results highlight an unexpected side of the 'obesity paradox' in HL.

Overview

  • The study analyzed the association between body mass index (BMI) and survival outcomes in patients with Hodgkin Lymphoma (HL) treated with nivolumab within the CheckMate 205 study.
  • The study found that patients with a lower BMI (<24.03 kg/m) had a longer progression-free survival (PFS) than those with a higher BMI (≥24.03 kg/m)
  • The study also developed a variable called BMCI (BMI cutoff with serum creatinine levels) to stratify patients into distinct PFS risk groups

Comparative Analysis & Findings

  • Patients with a BMCI (BMI ≥24.03 kg/m/sCr <0.7 mg/dL) displayed a threefold increased PFS risk (95% CI,1.6-5.7;< 0.001) than those with a BMCI (BMI <24.03 kg/m/sCr ≥0.7 mg/dL)
  • In a separate analysis of pretreated patients, those with a BMCI had a PFS risk 3.5-fold higher (95% CI,1.9-6.6;< 0.001) than patients with a BMCI
  • The BMCI maintained its independent significance in a multivariable model including attenuating factors and predictive biomarkers

Implications and Future Directions

  • The study highlights the importance of considering BMI in personalized treatment decisions for HL patients
  • Future studies should investigate the underlying mechanisms of the 'obesity paradox' in HL and explore novel biomarkers to predict treatment outcomes
  • The findings also suggest that lean body mass may play a role in determining response to nivolumab, which warrants further investigation
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