Higher BMI, But Not Sarcopenia, Is Associated With Pembrolizumab-related Toxicity in Patients With Advanced Melanoma

Anticancer Res. 2020 Sep;40(9):5245-5254. doi: 10.21873/anticanres.14528.


Background/aim: To determine whether BMI and sarcopenia were related to treatment-limiting toxicity or efficacy of pembrolizumab treatment in melanoma patients.

Patients and methods: Medical records for melanoma patients undergoing pembrolizumab treatment at Duke University from January 2014 to September 2018 were reviewed. Pre-treatment measurements such as BMI were collected. Pre-treatment CT imaging was used to determine psoas muscle index (PMI). Patients in the lowest sex-specific tertile of PMI were sarcopenic. Logistic regression measured associations with treatment toxicity and response. Kaplan-Meier analysis assessed progression-free survival (PFS) and overall survival (OS).

Results: Among 156 patients, the overall objective response rate was 46.2% and 29 patients (18.6%) experienced treatment-limiting toxicity. Sarcopenia was not significantly associated with toxicity, response, or survival. However, obese patients (BMI >30) experienced higher rates of toxicity (p=0.0007).

Conclusion: Sarcopenia did not appear to predict clinically relevant outcomes. Obesity, however, represents a readily available predictor of pembrolizumab toxicity.

Keywords: Melanoma; adverse reactions; body mass index; clinical decision-making; drug-related side effects; monoclonal antibodies; pembrolizumab; retrospective studies; sarcopenia.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antineoplastic Agents, Immunological / administration & dosage
  • Antineoplastic Agents, Immunological / adverse effects*
  • Body Mass Index*
  • Disease Susceptibility
  • Drug-Related Side Effects and Adverse Reactions / etiology*
  • Female
  • Humans
  • Male
  • Melanoma / complications*
  • Melanoma / diagnosis
  • Melanoma / drug therapy*
  • Melanoma / etiology
  • Middle Aged
  • Neoplasm Staging
  • Positron Emission Tomography Computed Tomography
  • Prognosis
  • Sarcopenia / complications
  • Tomography, X-Ray Computed
  • Young Adult


  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents, Immunological
  • pembrolizumab