Metabolic syndrome is independently associated with improved overall survival to first-line therapy with immune checkpoint inhibitors in non-small cell lung cancer

Maroun Bou Zerdan; Prashanth Ashok Kumar; Dulce M Barrios; Alanna Glidden; Dayana Nasr; Stephanie Niforatos; Ghanshyam Ghelani; Jennifer Leibovitch; Sandy Nasr; Binod Kc; Mulham Ombada; Farzam Khokhar; Bhavya Poudyal; Jenish Bhandari; Myera Shahnawaz; Stephen Graziano; Seah H Lim

doi:10.3389/fonc.2023.1134824

Metabolic syndrome is independently associated with improved overall survival to first-line therapy with immune checkpoint inhibitors in non-small cell lung cancer

Front Oncol. 2023 May 12:13:1134824. doi: 10.3389/fonc.2023.1134824. eCollection 2023.

Authors

Maroun Bou Zerdan¹, Prashanth Ashok Kumar², Dulce M Barrios¹, Alanna Glidden¹, Dayana Nasr¹, Stephanie Niforatos¹, Ghanshyam Ghelani², Jennifer Leibovitch², Sandy Nasr¹, Binod Kc¹, Mulham Ombada¹, Farzam Khokhar¹, Bhavya Poudyal¹, Jenish Bhandari¹, Myera Shahnawaz¹, Stephen Graziano², Seah H Lim²

Affiliations

¹ Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York, NY, United States.
² Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, NY, United States.

Abstract

Background: Many co-existing medical conditions may affect the outcome in patients treated with immune checkpoint inhibitors for advanced cancer. There is currently not any information on whether metabolic syndrome (MetS) impacts the clinical outcome in patients treated with immune checkpoint inhibitors (ICIs) for advanced non-small cell line cancer (NSCLC).

Methods: We carried out a single-center retrospective cohort study to determine the effects of MetS on first-line ICI therapy in patients with NSCLC.

Results: One hundred and eighteen consecutive adult patients who received first-line therapy with ICIs and had adequate medical record information for the determination of MetS status and clinical outcomes were included in the study. Twenty-one patients had MetS and 97 did not. There was no significant difference between the two groups in age, gender, smoking history, ECOG performance status, tumor histologic types, pre-therapy use of broad-spectrum antimicrobials, PD-L1 expression, pre-treatment neutrophil:lymphocyte ratio, or proportions of patients who received ICI monotherapy or chemoimmunotherapy. With a median follow-up of 9 months (range 0.5-67), MetS patients enjoyed significantly longer overall survival (HR 0.54, 95% CI: 0.31-0.92) (p = 0.02) but not progression-free survival. The improved outcome was only observed in patients who received ICI monotherapy and not chemoimmunotherapy. MetS predicted for higher probability of survival at 6 months (p = 0.043) and 12 months (p = 0.008). Multivariate analysis indicated that, in addition to the known adverse effects of use of broad-spectrum antimicrobials and the beneficial effects of PD-L1 (Programmed cell death-ligand 1) expression, MetS was independently associated with improved overall survival but not progression-free survival.

Conclusions: Our results suggest that MetS is an independent predictor of treatment outcome in patients who received first-line ICI monotherapy for NSCLC.

Keywords: chemoimmunotherapy; immune checkpoint inhibitors; metabolic syndrome; non-small cell lung cancer; treatment outcome.