Impact of visceral fat area as independent predictive factor in patients with advanced non-small cell lung cancer treated with nivolumab

Abstract Background A better identification of patients who are more likely to benefit from immune checkpoint inhibitors is warranted in advanced non-small cell lung cancer (NSCLC). In resent preclinical study, obesity was associated with increased efficacy of PD-1/PD-L1 blockage. Herein, we conducted a retrospective study to investigate the prognostic accuracy of body mass index (BMI) and computed tomography-defined fat area in patients with advanced NSCLC treated with nivolumab. Methods We retrospectively analyzed patients with advanced NSCLC who received nivolumab at our institute between January 2016 and January 2019. Clinical data including BMI, visceral fat area (VFA) and subcutaneous fat area (SFA), and progression free survival (PFS) were collected. Treatment outcome of nivolumab was assessed according to the Response Evaluation Criteria in Solid Tumors, version 1.1. Results In total, 126 patients were included in this study. High VFA (≥100cm2) were significantly associated with longer PFS, whereas high SFA (≥100cm2) and high BMI (≥25) were not. The objective response rates were higher in patients with high VFA than in those with low VFA (39% versus 19%; [P = 0.027], respectively). In multivariate analysis, high VSA (hazard ratio: 0.61, 95% confidence interval: 0.40–0.93; [P = 0.022]) and better PS (hazard ratio:0.35, 95% confidence interval: 0.19–0.68; [P = 0.003]) were identified as an independent predictor of longer PFS in patients treated with nivolumab. Conclusions In patients with advanced NSCLC who received nivolumab, high VFA were independent predictors of nivolumab efficacy. Legal entity responsible for the study Kobe City Medical Center General Hospital. Funding Has not received any funding. Disclosure Y. Sato: Speaker Bureau / Expert testimony: Ono Pharmaceutical Co., Ltd. D. Fujimoto: Speaker Bureau / Expert testimony: Ono Pharmaceutical Co., Ltd. K. Hosoya: Speaker Bureau / Expert testimony: Ono Pharmaceutical Co., Ltd. All other authors have declared no conflicts of interest.