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

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

doi:10.3389/fonc.2023.1141500

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

Front Oncol. 2023 Apr 17:13:1141500. doi: 10.3389/fonc.2023.1141500. eCollection 2023.

Authors

Lorena Incorvaia¹, Alessandra Dimino¹, Laura Algeri¹, Chiara Brando¹, Luigi Magrin¹, Ida De Luca¹, Erika Pedone¹, Alessandro Perez¹, Roberta Sciacchitano¹, Annalisa Bonasera², Tancredi Didier Bazan Russo¹, Federica Li Pomi³, Marta Peri¹, Valerio Gristina¹, Antonio Galvano¹, Dario Giuffrida², Ivan Fazio⁴, Francesca Toia⁵, Adriana Cordova⁵, Ada Maria Florena⁶, Antonio Giordano⁷, Viviana Bazan^{8

9}, Antonio Russo^{1

9}, Giuseppe Badalamenti¹

Affiliations

¹ Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy.
² Department of Oncology, Istituto Oncologico del Mediterraneo, Catania, Italy.
³ Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy.
⁴ Radiotherapy Unit, Clinica Macchiarella, Palermo, Italy.
⁵ Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
⁶ Pathologic Anatomy Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
⁷ Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, United States.
⁸ Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bind.), Section of Medical Oncology, University of Palermo, Palermo, Italy.
⁹ Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, Temple University, Philadelphia, PA, United States.

Abstract

Background: Merkel 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 methods: This 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.

Results: Thirty-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.

Conclusion: To 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.

Keywords: Merkel cell carcinoma (MCC); avelumab; body mass index - BMI; immunotherapy; predictive factors; skin cancer non melanoma.

Copyright © 2023 Incorvaia, Dimino, Algeri, Brando, Magrin, De Luca, Pedone, Perez, Sciacchitano, Bonasera, Bazan Russo, Li Pomi, Peri, Gristina, Galvano, Giuffrida, Fazio, Toia, Cordova, Florena, Giordano, Bazan, Russo and Badalamenti.