While being overweight increases the risk of developing lifestyle-related diseases, there is a phenomenon known as the obesity paradox where a decreased risk of death has been seen during cancer therapy. However, that paradox might not be the trend for all cancer therapies, an Osaka Metropolitan University team reports in JAMA Network Open, a publication of the American Medical Association.

Led by graduate student Mr. Yasutaka Ihara and Professor Ayumi Shintani of the Graduate School of Medicine’s Department of Medical Statistics, the team used a Japanese administrative claims database of more than 500,000 lung cancer patients and examined the relation between body mass index (BMI) and the risk of mortality during immunotherapy and conventional chemotherapy.

Focusing only on patients with advanced non-small cell lung cancer, the team found that the higher the BMI, the lower the risk of mortality when undergoing both immunotherapy and chemotherapy, though it does a U-turn around a BMI of 24. Patients with a BMI under 28 showed lower risk of mortality when undergoing immunotherapy compared to conventional chemotherapy, but for those at or over that figure, the risk increases with immunotherapy while it continues to get lower with chemotherapy.

“Immunotherapy might not always be the optimal treatment method for obese patients with advanced non-small cell lung cancer, so the use of conventional chemotherapy should also be considered,” Mr. Ihara stated. “In addition to BMI, age, hormones, and gut microbiota have been reported as factors that influence the effectiveness of immunotherapy. Evaluation of whether immunotherapy or conventional chemotherapy improves survival in the presence of these factors is expected to contribute to the development of precision medicine.”

Funding
This study was supported with funding from the Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine (Dr. Shintani).

Conflict of Interest Disclosures:
Dr. Sawa reported receiving personal fees from Taiho Pharmaceutical Co. Ltd., Chugai Pharmaceutical Co. Ltd., AstraZeneca KK, MSD KK, Ono Pharmaceutical Co. Ltd., and Nippon Kayaku Co. Ltd. outside the submitted work. Dr. Imai reported receiving personal fees from JCR Pharmaceuticals and Kyowa Kirin outside the submitted work. Dr. Shintani reported receiving personal fees from AbbVie, AstraZeneca, Asahi Kasei Corporation, Astellas Pharma, Bayer Yakuhin, Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Janssen Pharmaceutical, Kissei Pharmaceutical, Kyowa Kirin, Mallinckrodt Pharmaceuticals, Maruho, Merck Biopharma, Mitsubishi Tanabe Pharma Corporation, Nipro Corporation, Nippon Shinyaku, Novo Nordisk Pharma, Ono Pharmaceutical, Pfizer, Shionogi Pharma, Taisho Pharmaceutical, Takeda Pharmaceutical Company Limited, and Torii Pharmaceutical. No other disclosures were reported.

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Full bibliographic information

Published on 12/09/2024 by Osaka Metropolitan University
Journal: JAMA Network Open
Title: Immunotherapy and Overall Survival Among Patients With Advanced Non–Small Cell Lung Cancer and Obesity
DOI: 10.1001/jamanetworkopen.2024.25363
Author(s): Yasutaka Ihara, Kenji Sawa, Takumi Imai, Tsubasa Bito, Yuki Shimomura, Ryota Kawai, Ayumi Shintani
Publication date: 2 August 2024
URL: https://doi.org/10.1001/jamanetworkopen.2024.25363