Body mass index and baseline platelet count as predictive factors in Merkel cell carcinoma patients treated with avelumab

BackgroundMerkel cell carcinoma (MCC) is a rare and aggressive skin cancer, associated with a worse prognosis. The Immune Checkpoint Inhibitors (ICIs) avelumab and pembrolizumab have been recently approved as first-line treatment in metastatic MCC (mMCC). The clinical observation of improved outcome...

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Main Authors: Lorena Incorvaia, Alessandra Dimino, Laura Algeri, Chiara Brando, Luigi Magrin, Ida De Luca, Erika Pedone, Alessandro Perez, Roberta Sciacchitano, Annalisa Bonasera, Tancredi Didier Bazan Russo, Federica Li Pomi, Marta Peri, Valerio Gristina, Antonio Galvano, Dario Giuffrida, Ivan Fazio, Francesca Toia, Adriana Cordova, Ada Maria Florena, Antonio Giordano, Viviana Bazan, Antonio Russo, Giuseppe Badalamenti
Format: Article
Language:English
Published: Frontiers Media S.A. 2023-04-01
Series:Frontiers in Oncology
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fonc.2023.1141500/full
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author Lorena Incorvaia
Alessandra Dimino
Laura Algeri
Chiara Brando
Luigi Magrin
Ida De Luca
Erika Pedone
Alessandro Perez
Roberta Sciacchitano
Annalisa Bonasera
Tancredi Didier Bazan Russo
Federica Li Pomi
Marta Peri
Valerio Gristina
Antonio Galvano
Dario Giuffrida
Ivan Fazio
Francesca Toia
Adriana Cordova
Ada Maria Florena
Antonio Giordano
Viviana Bazan
Viviana Bazan
Antonio Russo
Antonio Russo
Giuseppe Badalamenti
author_facet Lorena Incorvaia
Alessandra Dimino
Laura Algeri
Chiara Brando
Luigi Magrin
Ida De Luca
Erika Pedone
Alessandro Perez
Roberta Sciacchitano
Annalisa Bonasera
Tancredi Didier Bazan Russo
Federica Li Pomi
Marta Peri
Valerio Gristina
Antonio Galvano
Dario Giuffrida
Ivan Fazio
Francesca Toia
Adriana Cordova
Ada Maria Florena
Antonio Giordano
Viviana Bazan
Viviana Bazan
Antonio Russo
Antonio Russo
Giuseppe Badalamenti
author_sort Lorena Incorvaia
collection DOAJ
description BackgroundMerkel cell carcinoma (MCC) is a rare and aggressive skin cancer, associated with a worse prognosis. The Immune Checkpoint Inhibitors (ICIs) avelumab and pembrolizumab have been recently approved as first-line treatment in metastatic MCC (mMCC). The clinical observation of improved outcomes in obese patients following treatment with ICIs, known as the “obesity paradox”, has been studied across many types of tumors. Probably due to the rarity of this tumor, data on mMMC patients are lacking.Patients and methodsThis is an observational, hospital-based, study to investigate the role of Body Mass Index (BMI) as predictive biomarker of ICI response in mMCC patients treated with avelumab as first-line treatment. The study population included the patients treated from February 2019 to October 2022 in an Italian referral center for rare tumors. Clinico-pathological characteristics, BMI, laboratory parameters (NLR and platelet count), and response to avelumab were analyzed from a MCC System database prospectively collected.ResultsThirty-two (32) patients were included. Notably, the presence of pre-treatment BMI ≥ 30 was significantly associated with longer PFS [BMI < 30 Group: median PFS, 4 months (95% CI: 2.5-5.4); BMI ≥ 30 Group: median PFS, not reached; p<0.001)[. Additionally, the median PFS was significantly higher in patients with higher PLT (median PFS: 10 months in the “low PLT” Group (95% CI: 4.9, 16.1) vs 33 months (95% CI: 24.3, 43.2) in the “high PLT” Group (p=0.006). The multivariable Cox regression model confirmed these results.ConclusionTo our knowledge, this is the first study that investigates the predictive role of BMI in MCC patients. Our data were consistent with the clinical observation of improved outcomes in obese patients across other tumor types. Thus, advanced age, a weakened immune system, and the obesity-associated “inflammaging”, are key factors that could impact the cancer immune responses of mMCC patients.
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spelling doaj.art-f2080b4c58df4c2da93ca0c2857999d32023-04-17T05:44:48ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-04-011310.3389/fonc.2023.11415001141500Body mass index and baseline platelet count as predictive factors in Merkel cell carcinoma patients treated with avelumabLorena Incorvaia0Alessandra Dimino1Laura Algeri2Chiara Brando3Luigi Magrin4Ida De Luca5Erika Pedone6Alessandro Perez7Roberta Sciacchitano8Annalisa Bonasera9Tancredi Didier Bazan Russo10Federica Li Pomi11Marta Peri12Valerio Gristina13Antonio Galvano14Dario Giuffrida15Ivan Fazio16Francesca Toia17Adriana Cordova18Ada Maria Florena19Antonio Giordano20Viviana Bazan21Viviana Bazan22Antonio Russo23Antonio Russo24Giuseppe Badalamenti25Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Oncology, Istituto Oncologico del Mediterraneo, Catania, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyDepartment of Oncology, Istituto Oncologico del Mediterraneo, Catania, ItalyRadiotherapy Unit, Clinica Macchiarella, Palermo, ItalyDivision of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, ItalyDivision of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, ItalyPathologic Anatomy Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, ItalySbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, United StatesDepartment of Biomedicine, Neuroscience and Advanced Diagnostics (Bind.), Section of Medical Oncology, University of Palermo, Palermo, ItalyInstitute for Cancer Research and Molecular Medicine and Center of Biotechnology, Temple University, Philadelphia, PA, United StatesDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyInstitute for Cancer Research and Molecular Medicine and Center of Biotechnology, Temple University, Philadelphia, PA, United StatesDepartment of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, ItalyBackgroundMerkel cell carcinoma (MCC) is a rare and aggressive skin cancer, associated with a worse prognosis. The Immune Checkpoint Inhibitors (ICIs) avelumab and pembrolizumab have been recently approved as first-line treatment in metastatic MCC (mMCC). The clinical observation of improved outcomes in obese patients following treatment with ICIs, known as the “obesity paradox”, has been studied across many types of tumors. Probably due to the rarity of this tumor, data on mMMC patients are lacking.Patients and methodsThis is an observational, hospital-based, study to investigate the role of Body Mass Index (BMI) as predictive biomarker of ICI response in mMCC patients treated with avelumab as first-line treatment. The study population included the patients treated from February 2019 to October 2022 in an Italian referral center for rare tumors. Clinico-pathological characteristics, BMI, laboratory parameters (NLR and platelet count), and response to avelumab were analyzed from a MCC System database prospectively collected.ResultsThirty-two (32) patients were included. Notably, the presence of pre-treatment BMI ≥ 30 was significantly associated with longer PFS [BMI < 30 Group: median PFS, 4 months (95% CI: 2.5-5.4); BMI ≥ 30 Group: median PFS, not reached; p<0.001)[. Additionally, the median PFS was significantly higher in patients with higher PLT (median PFS: 10 months in the “low PLT” Group (95% CI: 4.9, 16.1) vs 33 months (95% CI: 24.3, 43.2) in the “high PLT” Group (p=0.006). The multivariable Cox regression model confirmed these results.ConclusionTo our knowledge, this is the first study that investigates the predictive role of BMI in MCC patients. Our data were consistent with the clinical observation of improved outcomes in obese patients across other tumor types. Thus, advanced age, a weakened immune system, and the obesity-associated “inflammaging”, are key factors that could impact the cancer immune responses of mMCC patients.https://www.frontiersin.org/articles/10.3389/fonc.2023.1141500/fullMerkel cell carcinoma (MCC)avelumabbody mass index - BMIpredictive factorsimmunotherapyskin cancer non melanoma
spellingShingle Lorena Incorvaia
Alessandra Dimino
Laura Algeri
Chiara Brando
Luigi Magrin
Ida De Luca
Erika Pedone
Alessandro Perez
Roberta Sciacchitano
Annalisa Bonasera
Tancredi Didier Bazan Russo
Federica Li Pomi
Marta Peri
Valerio Gristina
Antonio Galvano
Dario Giuffrida
Ivan Fazio
Francesca Toia
Adriana Cordova
Ada Maria Florena
Antonio Giordano
Viviana Bazan
Viviana Bazan
Antonio Russo
Antonio Russo
Giuseppe Badalamenti
Body mass index and baseline platelet count as predictive factors in Merkel cell carcinoma patients treated with avelumab
Frontiers in Oncology
Merkel cell carcinoma (MCC)
avelumab
body mass index - BMI
predictive factors
immunotherapy
skin cancer non melanoma
title Body mass index and baseline platelet count as predictive factors in Merkel cell carcinoma patients treated with avelumab
title_full Body mass index and baseline platelet count as predictive factors in Merkel cell carcinoma patients treated with avelumab
title_fullStr Body mass index and baseline platelet count as predictive factors in Merkel cell carcinoma patients treated with avelumab
title_full_unstemmed Body mass index and baseline platelet count as predictive factors in Merkel cell carcinoma patients treated with avelumab
title_short Body mass index and baseline platelet count as predictive factors in Merkel cell carcinoma patients treated with avelumab
title_sort body mass index and baseline platelet count as predictive factors in merkel cell carcinoma patients treated with avelumab
topic Merkel cell carcinoma (MCC)
avelumab
body mass index - BMI
predictive factors
immunotherapy
skin cancer non melanoma
url https://www.frontiersin.org/articles/10.3389/fonc.2023.1141500/full
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