Dr. Weeks’ Comment: In the fall of 2017 I gave a provocative lecture which described the symptom as a “healing gesture” in the words of Dr. Samuel Hahnemann. The symptom is often adaptive and beneficial, in addition to pointing us to the cause of the problem. And now, more data that obesity – an oft maligned state of being overweight is beneficial if you have cancer…
Intriguing: Better Survival in Melanoma in Obese Men
An analysis of nearly 2000 patients with metastatic melanoma who were treated with targeted therapies or immunotherapies has found that for patients who were classified as obese (ie, who had a body mass index [BMI] ≥30), survival was significantly longer than for patients who were of normal weight. But this finding was noted only in male patients — women did not show this effect.
“Obese men consistently did much better than men with a normal BMI, with nearly a doubling of overall survival,” said lead author Jennifer McQuade, MD, who is an instructor of melanoma medical oncology at the University of Texas MD Anderson Cancer Center (MDACC), Houston. There were no significant differences in survival between women with normal BMI, those who were overweight, and those who were obese.
The finding comes from analyses of six cohorts of 1918 patients. Treatment regimens differed among cohorts and ranged from targeted approaches with BRAF/MEK inhibitors, immunotherapies, and chemotherapies. The improved, durable responses were seen in patients with stage IV metastatic melanoma who were treated with targeted therapies and immunotherapies but not with cytotoxic chemotherapy.
The study was published online February 12 in Lancet Oncology.
A similar phenomenon has been described in other cancers, note Andrew J. Hayes, MBBS, PhD, and James Larkin, MD, PhD, of the Royal Marsden National Health System Trust, London, United Kingdom, in an accompanying commentary.
Observational studies across several tumor types have shown that a moderate increase in BMI is associated with improved outcomes at the time of treatment and during follow-up periods. “However, this protective effect is almost universally reversed as BMI increases to the morbidly obese level, an effect referred to as the obesity paradox,” the editorialists note.
Unlike these previous studies, in this study in patients with metastatic melanoma, “there is a linear relation between benefit and increasing BMI in male patients through to the morbidly obese levels,” Hayes and Larkin note. This supports the idea that there may be an underlying biological mechanism, they add.
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