Pembrolizumab leads to higher toxicity risk in obese melanoma patients

A retrospective study found a significant association between BMI and treatment toxicity in patients with advanced melanoma treated with pembrolizumab. Neither survival nor toxicity were linked to sarcopenia [1].

Pembrolizumab, a monoclonal antibody against programmed cell death-1, is currently used as first-line therapy for patients with advanced melanoma. Because both cachexia and obesity can affect treatment response to immunotherapy for cancer patients, this retrospective study aimed to assess whether characteristics like obesity, sarcopenia, and other baseline characteristics may impact therapy success or appearance of toxicity.

Data was collected from patients with advanced melanoma receiving pembrolizumab treatment between January 2014 and September 2018 at Duke University (USA). No association for sarcopenia was found (P=0.88), but patients with higher levels of albumin were identified to have better chances for disease control. The likelihood of toxicity was influenced by BMI (P=0.0004) but not by sarcopenia (P=0.95). Compared with patients with a normal/low BMI <25 (11.9%) or overweight patients (BMI ≥25-<30; 7.1%), obese patients (BMI ≥30; 34.5%) had a higher likelihood of ending treatment due to toxicity. Furthermore, lower creatinine was associated with a greater proportion of toxicity. The researchers believe that these results have the potential to impact the decision-making process of choosing one drug versus another for individual patients based on their baseline characteristics.

1. Ravichandran S, et al. Late-breaking Abstract, AAD Virtual Meeting Experience, 12-14 June 2020.

Posted on 6 August 20205 January 2021