A recent study published in Gynecologic Oncology found that among patients with endometrial cancer (EC) who receive pembrolizumab, elevated body mass index (BMI) is associated with shorter progression-free survival.
“This effect was most pronounced among White and Black obese patients in comparison to White non-obese patients, particularly in those treated with pembrolizumab and Lenvatinib,” the authors wrote.
Obesity is not only a risk factor for developing EC but may also be a predictor of negative patient outcomes. However, few studies have evaluated how responses to immunotherapies such as pembrolizumab vary by BMI.
The study included 167 patients with advanced or recurrent EC who underwent treatment with pembrolizumab. Of these, 79 also received Lenvatinib and 45 also received chemotherapy.
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Participants had an overall response rate of 32%. The complete response rate was 17.4%, and the partial response rate was 14.6%. Response rate did not differ between Black and white individuals.
Patients with a BMI of at least 40 had poorer progression-free survival than those with a BMI between 30 and 40. Overall survival did not differ by race or obesity, though.
The authors then investigated differences by tumor molecular subtype. They found that individuals with MMRd tumors had a greater response rate than those with MMRp tumors. This association was not significantly different by race.
Among patients who had mutations in the p53 gene, 68.2% of those with a BMI below 30 responded to pembrolizumab, compared to 50% of those with a BMI of 30 or higher. Among those without p53 mutations, the overall response rate remained at 60% across all BMI categories.
Many subgroups included in their analysis contained very few individuals, the authors cautioned, limiting their ability to make definitive conclusions.
“These results should be considered hypothesis-generating and highlight the need for larger, prospective studies that incorporate more refined measures of obesity, metabolic health, and molecular biomarkers,” they wrote. “Given the high prevalence of obesity in EC, clarifying these relationships will be critical to optimizing immunotherapy strategies for this population.”
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