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What is the link between obesity and mortality in metastatic melanoma?
Did you know that obesity has been linked to increased mortality in several cancer types? The relation between obesity and survival outcomes in metastatic melanoma, however, have thus far remained unknown. So, a retrospective, multi-cohort study examined the association between body-mass index and progression-free survival or overall survival in patients with metastatic melanoma who received targeted therapy, immunotherapy, or chemotherapy.
The study analysed independent cohorts of patients with metastatic melanoma assigned to treatment with targeted therapy, immunotherapy, or chemotherapy in randomised clinical trials. Patients were classified according to body-mass index as underweight, normal, overweight, or obese. Underweight patients and those without body-mass index were excluded from the study. The primary outcomes were the associations between body-mass index and progression-free survival or overall survival, stratified by treatment type and sex.
A total of 1,918 patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy between August 2006 and January 2016 were included in the analysis. There were 599 patients treated with dabrafenib plus trametinib targeted therapy; 240 patients treated with vemurafenib plus cobimetinib targeted therapy; 207 patients treated with ipilimumab plus dacarbazine immunotherapy; 331 patients treated with pembrolizumab, nivolumab, or atezolizumab immunotherapy; and 541 patients treated with dacarbazine chemotherapy.
In total, 694 patients (36 per cent) were classified according to body-mass index as normal; 711 patients (37 per cent) were overweight; and 513 patients (27 per cent) were obese.
The study found that obesity, compared with normal body-mass index, was associated with improved survival in patients with metastatic melanoma. This survival benefit associated with obesity was restricted to patients treated with targeted therapy and immunotherapy. No associations were observed with chemotherapy.
The association of body-mass index with overall survival for patients treated with targeted and immune therapies differed by sex, with inverse associations in men, but no associations observed in women.
These results suggest that in patients with metastatic melanoma, obesity is associated with improved progression-free survival and overall survival compared with those outcomes in patients with normal body-mass index, and that this association is mainly seen in male patients treated with targeted or immune therapy.
The study outcomes have implications for the design of future clinical trials for patients with metastatic melanoma. Further, the magnitude of the benefit supports further investigation of the underlying mechanism of these associations.
Jennifer L McQuade, Carrie R Daniel, Kenneth R Hess, Douglas B Johnson, Alexander M Menzies, Michael A Davies, et al. February 12, 2018. Association of body-mass index and outcomes in patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy: a retrospective, multicohort analysis. The Lancet Oncology. Volume 19. Issue 3. Pages 310-322. Published March 01, 2018. DOI: https://doi.org/10.1016/S1470-2045(18)30078-0
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