Impact of Baseline Body Mass Index on Immunotherapy Outcomes in Patients With Non-small-cell Lung Cancer

Background/Aim: Assessment of nutritional status plays an important role in treatment of patients with lung cancer. We conducted a real-world study to investigate the potential prognostic value of baseline body mass index (BMI) in patients with non-small-cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs).

Patients and Methods: We retrospectively analysed data from 154 patients with advanced NSCLC treated with ICIs in the first or second line. Patients were stratified into two groups: BMI <25 kg/m² and BMI ≥25 kg/m². We investigated the impact of BMI on overall survival (OS), progression-free survival (PFS), time to treatment failure (TTF), and objective response rate (ORR) across the overall population and within prespecified subgroups defined by BMI.

Results: Patients with BMI ≥25 kg/m² (n=88) had a significantly better ORR compared to those with BMI <25 kg/m² (n=66): 78.4% vs. 62.1%, p=0.03. There was no significant improvement in PFS, TTF or OS in the overall population. Subgroup analyses showed significant improvement in OS in favour of the BMI ≥25 kg/m² group in non-smokers, in the subgroup receiving first-line immunotherapy, and in the subgroup with high expression of programmed cell death ligand 1. There was significant improvement in ORR in favour of the BMI ≥25 kg/m² group in several subgroups. No significant improvements in PFS and TTF in subgroup analyses were observed.

Conclusion: Our real-world study suggests that BMI might potentially act as a predictor for ORR in patients with advanced NSCLC treated with ICIs and should be considered in treatment decision-making. Additionally, we also observed a positive trend in OS among this group of patients.