scholarly journals P01.06 Overweight and obesity as biomarkers for survival outcomes and immune related adverse events undergoing immunotherapy – a systematic review and meta-analysis

2021 ◽  
Vol 9 (Suppl 1) ◽  
pp. A5.2-A6
Author(s):  
P Trinkner ◽  
S Günther ◽  
M von Bergwelt ◽  
D Cordas dos Santos ◽  
S Theurich
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Obese Patients ◽  
Increased Risk ◽  
Underweight Patients ◽  
The Impact

BackgroundThe impact of overweight/obesity in cancer patients treated with immune checkpoint inhibitors (ICIs) is controversial. To further contribute to this debate, we performed a systematic review and meta-analysis of published articles evaluating the effects of overweight/obesity on survival and immune-related adverse events (irAEs).Materials and MethodsIn analogy to Cochrane recommendations, systematic literature searches included all published articles in PubMed until February 2021 with key terms ‘obesity’ and ‘overweight’ and ICI treatment irrespective of cancer entity and ICI used. Further selection criteria for meta-analysis included WHO cut-offs for overweight/obesity. For the random effects meta-analysis, we used Hazard Ratios (HR) for overall and progression-free survival (OS, PFS) and Odds Ratios (OR) for occurrence of irAEs with corresponding 95% confidence intervals (95%CI), respectively.ResultsA total of 30 studies (12,895 patients, 38% female) selected for meta-analysis revealed a superior survival of overweight/obese patients (PFS: HR 0.9, 95%CI 0.77-1.04, p = 0.11; OS: 0.74, 95%CI 0.63-0.92, p = 0.0005) compared to normal weight patients. In subgroup analyses based on sex, overweight/obese male patients showed increased survival (PFS: HR 0.79, 95%CI 0.63-1.00, p = 0.05; OS: 0.71, 95%CI 0.58-0.86, p = 0.0005), whereas overweight/obese female patients had similar survival probabilities compared to their normal weight counterparts (PFS: HR 1.01, 95%CI 0.69-1.47, p = 0.96; OS: HR 0.73, 95%CI 0.48-1.10, p = 0.13). Underweight patients showed inferior survival (PFS: HR 1.48, 95%CI 1.07-2.04, p = 0.02; OS: HR 1.86, 95%CI 1.13-3.04, p = 0.01). In addition, overweight/obese patients had a higher risk of developing irAEs with grade ≥ 3 (OR 1.91, 95%CI 1.18-3.10, p = 0.008).ConclusionsOur meta-analysis revealed that overweight/obesity is a beneficial factor for PFS and OS in a mixed cohort of cancer patients undergoing ICI treatment accompanied by an increased risk of severe irAEs. The differences between overweight/obese males and overweight/obese females might point to sex specific adipose distribution patterns and interactions of sex steroids on a molecular level. A significant number of studies included underweight patients into normal weight control groups which led to a compromised interpretation of the data and should be addressed in future studies.Disclosure InformationP. Trinkner: None. S. Günther: None. M. von Bergwelt: None. D. Cordas dos Santos: None. S. Theurich: None.

scholarly journals Healthcare utilisation in overweight and obese children: a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e035676
Author(s):  
Taimoor Hasan ◽  
Tom S Ainscough ◽  
Jane West ◽  
Lorna Katharine Fraser
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Healthcare Utilisation ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Obese Children ◽  
Outpatient Visits ◽  
Ed Visits ◽  
The Impact

ObjectiveThis systematic review and meta-analysis aims to systematically analyse the association of overweight and obesity with health service utilisation during childhood.Data sourcesPubMed, MEDLINE, CINAHL, EMBASE and Web of Science.MethodsObservational studies published up to May 2020 that assessed the impact of overweight and obesity on healthcare utilisation in children and adolescents were included. Studies were eligible for inclusion if the included participants were ≤19 years of age. Findings from all included studies were summarised narratively. In addition, rate ratios (RRs) and 95% CIs were calculated in a meta-analysis on a subgroup of eligible studies.Outcome measuresIncluded studies reported association of weight status with healthcare utilisation measures of outpatient visits, emergency department (ED) visits, general practitioner visits, hospital admissions and hospital length of stay.ResultsThirty-three studies were included in the review. When synthesising the findings from all studies narratively, obesity and overweight were found to be positively associated with increased healthcare utilisation in children for all the outcome measures. Six studies reported sufficient data to meta-analyse association of weight with outpatient visits. Five studies were included in a separate meta-analysis for the outcome measure of ED visits. In comparison with normal-weight children, rates of ED (RR 1.34, 95% CI 1.07 to 1.68) and outpatient visits (RR 1.11, 95% CI 1.02 to 1.20) were significantly higher in obese children. The rates of ED and outpatient visits by overweight children were only slightly higher and non-significant compared with normal-weight children.ConclusionsObesity in children is associated with increased healthcare utilisation. Future research should assess the impact of ethnicity and obesity-associated health conditions on increased healthcare utilisation in children with overweight and obesity.PROSPERO registration numberCRD42018091752

scholarly journals P01.08 Sarcopenia as biomarker for immunotherapy outcomes and immune-related adverse events – a systematic review and meta-analysis

2021 ◽  
Vol 9 (Suppl 1) ◽  
pp. A7.1-A7
Author(s):  
S Günther ◽  
P Trinkner ◽  
M von Bergwelt ◽  
D Cordas dos Santos ◽  
S Theurich
Keyword(s):  
Systematic Review ◽  
Skeletal Muscle ◽  
Risk Factor ◽  
Adverse Events ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Lumbar Vertebrae ◽  
Psoas Muscle ◽  
Skeletal Muscle Index ◽  
The Impact

BackgroundSarcopenia is an established risk factor for oncologic treatments like surgical interventions and conventional chemotherapy. However, the impact of sarcopenia on treatment and immune-related adverse events (irAEs) of cancer patients treated with immune checkpoint inhibitors (ICIs) continues to be debated. Therefore, we performed a systematic review and meta-analysis of all published articles evaluating the effects of sarcopenia on survival outcomes and irAEs of patients undergoing ICI treatment.Materials and MethodsIn analogy to the Cochrane guidelines for systematic reviews, we performed a systematic literature search including all published articles in PubMed until February 2021 for the key terms ‘sarcopenia’ or ‘sarcopenic obesity’ in combination with several terms for ICI treatments, irrespective of cancer entity and ICI used. Further selection criteria for meta-analysis included defined cut-offs for sarcopenia. Reported outcomes included progression-free survival (PFS), overall survival (OS) and the frequency of irAEs. For the random effects meta-analysis, we used Hazard Ratios (HR) for OS and PFS and Odds Ratios (OR) for occurrence of irAEs with corresponding 95% confidence intervals (95%CI), respectively.ResultsA total of 15 studies with 1,428 patients were selected to be eligible for meta-analysis. To evaluate muscle mass, all studies used CT-derived body composition parameters at the third lumbar vertebrae level and defined sarcopenia by using skeletal muscle index (SMI), psoas muscle index (PMI) or skeletal muscle density (SMD). Sarcopenic patients showed an inferior survival compared to non-sarcopenic patients with a combined HR for PFS with 1.53 (95%CI 1.23-1.91, p= 0.0001) and for OS with 1.6 (95% CI 1.23-2.09, p= 0,0005). Frequency of irAEs did not differ between sarcopenic and non-sarcopenic patients regardless of irAE grade (irAEs of grade≥3: OR 1.14, 95%CI 0.65-2.01, p = 0.64, irAEs of any grade: OR 0.96, 95%CI 0.65-1.42, p = 0.85).ConclusionsThis is the first meta-analysis that assessed sarcopenia in a mixed cohort of cancer patients. It revealed that sarcopenia is an adverse risk factor for survival of patients undergoing ICI treatment without affecting the risk of developing irAEs. Future studies may address sarcopenia as a patient-derived risk factor emphasizing the importance of nutrition and physical activity interventions.Disclosure InformationS. Günther: None. P. Trinkner: None. M. von Bergwelt: None. D. Cordas dos Santos: None. S. Theurich: None.

Antifungal Prophylaxis in Cancer Patients After Chemotherapy or Hematopoietic Stem-Cell Transplantation: Systematic Review and Meta-Analysis

2007 ◽  
Vol 25 (34) ◽  
pp. 5471-5489 ◽  
Author(s):  
Eyal Robenshtok ◽  
Anat Gafter-Gvili ◽  
Elad Goldberg ◽  
Miriam Weinberger ◽  
Moshe Yeshurun ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Adverse Events ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Antifungal Prophylaxis ◽  
Hematopoietic Stem ◽  
All Cause Mortality ◽  
Related Mortality

Purpose To evaluate the effect of antifungal prophylaxis on all-cause mortality as primary outcome, invasive fungal infections (IFIs), and adverse events. Many studies have evaluated the role of antifungal prophylaxis in cancer patients, with inconsistent conclusions. Methods We performed a systematic review and meta-analysis of randomized, controlled trials comparing systemic antifungals with placebo, no intervention, or other antifungal agents for prophylaxis in cancer patients after chemotherapy. The Cochrane Library, MEDLINE, conference proceedings, and references were searched. Two reviewers independently appraised the quality of trials and extracted data. Results Sixty-four trials met inclusion criteria. Antifungal prophylaxis decreased all-cause mortality significantly at end of follow-up compared with placebo, no treatment, or nonsystemic antifungals (relative risk [RR], 0.84; 95% CI, 0.74 to 0.95). In allogeneic hematopoietic stem-cell transplantation (HSCT) recipients, prophylaxis reduced all-cause mortality (RR, 0.62; 95% CI, 0.45 to 0.85), fungal-related mortality, and documented IFI. In acute leukemia patients, there was a significant reduction in fungal-related mortality and documented IFI, whereas the difference in mortality was only borderline significant (RR, 0.88; 95% CI, 0.74 to 1.06). Prophylaxis with itraconazole suspension reduced documented IFI when compared with fluconazole, with no difference in survival, and at the cost of more adverse events. On the basis of two studies, posaconazole prophylaxis reduced all-cause mortality (RR, 0.74; 95% CI, 0.56 to 0.98), fungal-related mortality, and IFI when compared with fluconazole. Conclusion Antifungal prophylaxis decreases all-cause mortality significantly in patients after chemotherapy. Antifungal prophylaxis should be administered to patients undergoing allogeneic HSCT, and should probably be administered to high-risk acute leukemia patients.

scholarly journals Effect of anticoagulants and antiplatelet agents on the efficacy of intravesical BCG treatment of bladder cancer: A systematic review

2013 ◽  
Vol 7 (11-12) ◽  
pp. 740 ◽  
Author(s):  
Nader Fahmy ◽  
Alejandro Lazo-Langner ◽  
Alla E. Iansavichene ◽  
Stephen E. Pautler
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Bladder Tumour ◽  
Antiplatelet Agents ◽  
Protective Role ◽  
Protective Effects ◽  
Increased Risk ◽  
Intravesical Bcg ◽  
The Impact ◽  
Group 1

We performed a systematic review of publications describing a correlation between oral anticoagulant medications and intravesical BCG outcome. We collected information on the impact of such medications on tumour recurrence and progression and we excluded papers not reporting outcome correlations. Patients were divided into group 1 and 2 based on whether they were taking or not taking any anticoagulant medications. A total of 7 manuscripts published between 1990 and 2009 were included in this study. Data heterogeneity precluded meta-analysis. In studies combining all anticoagulant medications, 3 out of 5 (60%) publications did not identify any difference in outcome, while 2 (40%) documented significantly more recurrences in group 1 patients. In studies performing multivariate analysis and only examining the intake of 1 medication, warfarin alone seemed to be associated with increased risk of bladder tumour recurrences and progression following intravesical BCG treatment, while ASA alone seemed to be associated with more protective effects. There is no strong evidence to support the allegations of a protective role of ASA and a deleterious role for warfarin. Further, well-designed experimental and clinical studies are needed to clarify the mechanism of action of intravesical BCG along with possible drug interactions. 

Obesity Does Not Preclude Safe and Effective Myeloablative Hematopoietic Cell Transplantation (HCT) for Acute Myeloid Leukemia (AML) in Adults

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 51-51
Author(s):  
Willis H. Navarro ◽  
Manza-A Agovi ◽  
Brent Logan ◽  
Andrea Bacigalupo ◽  
Karen K Ballen ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Weight Group ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference ◽  
Underweight Patients ◽  
Autologous Hct ◽  
Weight Groups

Abstract INTRODUCTION: Obesity is increasingly common in the US and is frequently associated with co-morbid medical conditions that may increase the risk of HCT, often the optimal treatment for AML. HCT risk and outcomes for AML on the basis of body mass index (BMI) have not been well-characterized. Using data from the Center for International Blood and Marrow Transplant Research (CIBMTR), we have previously shown no significant difference in outcomes for autologous HCT for lymphoma among normal weight, overweight, and obese patients (pts) but worse outcomes for underweight pts (Navarro et al, BBMT 2006, 12(5): 541–51). Here, we compare outcomes by weight groups for AML patients who underwent autologous, related, or unrelated HCT. METHODS: Our final population included patients age ≥ 18 who underwent myeloablative unpurged autologous or allogeneic HCT for AML in 1st or 2nd complete remission, primary induction failure, or 1st relapse reported to the CIBMTR from 1995 to 2004. Cord blood HCTs were excluded. Four weight groups were defined based on BMI (BMI=weight (kg)/ height (m2)): underweight <18; normal=18–25; overweight >25–30; and obese >30. Treatment-related mortality (TRM), relapse, leukemia-free survival (LFS), and overall survival (OS) were compared using multivariable proportional hazards regression analysis accounting for patient, disease and HCT-related variables. RESULTS: We included 373 autologous, 2041 related, and 1801 unrelated transplant recipients. Patient-, disease-, and transplant characteristics were well-matched across weight groups and transplant types. Multivariable analysis examining risks (95% confidence intervals) relative to the normal weight group are: HCT Type Normal Underweight Overweight Obese -- =not done due to insufficient number of pts; NS=not significant; treatment failure = death or recurrence of disease. Autologous n=164 n=5 n=112 n=81 Death -- NS NS Treatment failure -- NS NS Relapse -- NS NS TRM -- NS NS Related Allogeneic n=1161 n=31 n=543 n=268 Death 1.86 (1.24–2.78) NS 1.23 (1.04–1.47) Treatment failure 2.08 (1.37–3.15) NS 1.19 (1.00–1.42) Relapse 2.02 (1.18–3.47) NS NS TRM 2.22 (1.17–4.22) NS 1.32 (1.02–1.70) Unrelated Allogeneic n=846 n=31 n=523 n=368 Death NS NS NS Treatment failure NS NS NS Relapse NS 0.82 (0.68–0.99) 0.76 (0.60–0.96) TRM NS NS NS CONCLUSIONS: There were no significant differences in risk of TRM, LFS, relapse or OS for normal weight, overweight or obese patient groups who received autologous HCT. Obese recipients of related HCT for AML had increased risk of death, treatment failure, and TRM, though the magnitude was small, an effect was not seen in the unrelated HCT group. Underweight patients who received a related, but not unrelated HCT, fared substantially worse than normal weight patients for all outcomes. It may be that the higher risk of the unrelated HCT procedure masks important but less obvious risks associated with being underweight whereas in the related donor HCT setting, such risks become manifest. Small numbers of patients limit the ability to better characterize this finding in underweight patients. Disproportionately, fewer transplants have been reported in underweight patients which suggest they experience disease and patient-related factors that preclude transplantation. No differences were observed for incidence of acute or chronic GVHD for any weight group. Overweight and obesity should not be a barrier to HCT; however, caution should be exercised in selecting underweight patients for HCT.

Impact of obesity in patients with metastatic urothelial carcinoma.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 346-346
Author(s):  
Amanda Leiter ◽  
John Doucette ◽  
Susanne Krege ◽  
Chia-Chi Lin ◽  
Noah M. Hahn ◽  
...  
Keyword(s):  
Adverse Events ◽  
Urothelial Cancer ◽  
Normal Weight ◽  
Phase Iii ◽  
Survival Outcomes ◽  
Similar Response ◽  
Obese Patients ◽  
Metastatic Urothelial Cancer ◽  
Significant Difference ◽  
The Impact

346 Background: Obesity has been associated with worse outcomes in patients with clinically localized urothelial cancer. However, the impact of obesity on outcomes of patients with metastatic disease has not previously been evaluated. Methods: Data from 537 patients were aggregated from eight phase II and phase III clinical trials investigating first-line cisplatin-based combination therapy in metastatic urothelial cancer. Chemotherapy regimen, adverse events, treatment response, and survival outcomes were compared across body mass index (BMI) and body surface area (BSA) categories. Results: BMI was classified according to WHO criteria (<18.5 underweight (4.1 % of patients), 18.5-24.99 normal weight (42.8%), 25-29.99 overweight (41.0%), >30 obese (12.1%)). BSA was classified as either below (56.8% of patients) or greater than or equal to (43.2%) the European average (1.91 m2 for males and 1.71 m2 for females). There was no significant difference in number of chemotherapy cycles across BMI and BSA categories. Patients’ treatment regimens significantly differed across BMI (p=0.02) and BSA (p<0.01) categories, with patients with higher BMI category and average or above BSA more likely to receive gemcitabine-cisplatin-based therapy rather than MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin)-based or other therapy regimens. There was no significant difference in adverse events across BMI categories, but the incidence of embolic events was significantly higher in patients with an average or higher BSA (6.6%) than those with a lower than average BSA (2.7%) (p=0.03). There was no significant difference in response rate or survival outcomes (overall and progression-free) amongst BMI and BSA categories. Conclusions: Obese patients with metastatic urothelial cancer on cisplatin-based therapies have similar response rates and survival outcomes to non-obese patients. Toleration of cisplatin-based therapy is similar across BMI and BSA categories, with the exception of a higher incidence of embolic events in patients with an above average BSA.

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