To the Editor We read with great interest the study by Kichenadasse et al1 in which the authors used individual patient-level data from 2110 clinical trial participants with locally advanced/metastatic non–small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors or chemotherapy to assess the association of body mass index (BMI) with survival outcomes and treatment-related toxic effects. The authors found that, among atezolizumab-treated patients, baseline BMI of 30 or greater was significantly associated with improved overall and progression-free survival compared with patients whose BMI was 18.5 to 29.9. Among atezolizumab-treated patients, obesity was not associated with an increased frequency of adverse events, and results did not differ by sex. These findings were not present in the chemotherapy-treated cohort. The authors concluded that “baseline BMI should therefore be considered as a stratification factor in future immune checkpoint inhibitor therapy trials.”1 Although the authors nicely demonstrate that BMI may be a predictive factor for patients with advanced NSCLC treated with immunotherapy, we believe that more research is needed prior to using BMI as a stratification factor for clinical trials.
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Sanchez A, Furberg H. Obesity Paradox in Patients With Non–Small Cell Lung Cancer Treated With Immunotherapy. JAMA Oncol. 2020;6(6):940–941. doi:10.1001/jamaoncol.2020.0634
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