Another Fat Paradox - Fat Men More Likely To Survive “therapy” For Metastatic Melanoma

[ecstatichamster]

https://www.sciencedirect.com/science/article/pii/S1470204518300780

The six cohorts consisted of a total of 2046 patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy between Aug 8, 2006, and Jan 15, 2016. 1918 patients were included in the analysis. Two cohorts containing patients from randomised controlled trials treated with targeted therapy (dabrafenib plus trametinib [n=599] and vemurafenib plus cobimetinib [n=240]), two cohorts containing patients treated with immunotherapy (one randomised controlled trial of ipilimumab plus dacarbazine [n=207] and a retrospective cohort treated with pembrolizumab, nivolumab, or atezolizumab [n=331]), and two cohorts containing patients treated with chemotherapy (two randomised controlled trials of dacarbazine [n=320 and n=221]) were classified according to BMI as normal (694 [36%] patients), overweight (711 [37%]), or obese (513 [27%]). In the pooled analysis, obesity, compared with normal BMI, was associated with improved survival in patients with metastatic melanoma (average adjusted hazard ratio

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0·77 [95% CI 0·66–0·90] for progression-free survival and 0·74 [0·58–0·95] for overall survival). The survival benefit associated with obesity was restricted to patients treated with targeted therapy (HR 0·72 [0·57–0·91] for progression-free survival and 0·60 [0·45–0·79] for overall survival) and immunotherapy (HR 0·75 [0·56–1·00] and 0·64 [0·47–0·86]). No associations were observed with chemotherapy (HR 0·87 [0·65–1·17, pinteraction=0·61] for progression-free survival and 1·03 [0·80–1·34, pinteraction=0·01] for overall survival). The association of BMI with overall survival for patients treated with targeted and immune therapies differed by sex, with inverse associations in men (HR 0·53 [0·40–0·70]), but no associations observed in women (HR 0·85 [0·61–1·18, pinteraction=0·03]).

Interpretation
Our results suggest that in patients with metastatic melanoma, obesity is associated with improved progression-free survival and overall survival compared with those outcomes in patients with normal BMI, and that this association is mainly seen in male patients treated with targeted or immune therapy. These results have implications for the design of future clinical trials for patients with metastatic melanoma and the magnitude of the benefit found supports further investigation of the underlying mechanism of these associations.

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Seems like an argument for “targeted therapy” but interesting nonetheless.

 

[lampofred]

Apparently small people produce less ATP than big people... (not just referring to fat mass though, sizes of all types of tissue considered)

 

[milkboi]

Apparently small people produce less ATP than big people... (not just referring to fat mass though, sizes of all types of tissue considered)

Hmm that might be true.. but isn’t that just because they have more cells? The relative amount of ATP to the amount of cells is probably more important.

 

[tara]

Interesting. Good that these studies get published too.

I tend to think, though, that if there's any paradox, it's in the labelling of the BMI ranges.

 

[lvysaur]

Fat people have less thymal atrophy, and thus probably better general immune function.
Thus they should be better protected against progressing cancer (or viruses).
Thymus Function: Higher In The Young/fat/female/Asian

Thymosin Alpha1-Fc Modulates The Immune System And Down-regulates The Progression Of Melanoma And Br