Nutritional status as a predictive biomarker for immunotherapy outcomes in advanced head and neck cancer

Meytal Guller, Matthew Herberg, Neha Amin, Hosam Alkhatib, Christopher Maroun, Evan Wu, Hailey Allen, Ying Zheng, Christine Gourin, Peter Vosler, Marietta Tan, Wayne Koch, David Eisele, Tanguy Seiwert, Carole Fakhry, Drew Pardoll, Gangcai Zhu, Rajarsi Mandal

Research output: Contribution to journalArticlepeer-review


The association between pretreatment nutritional status and immunotherapy response in patients with advanced head and neck cancer is unclear. We retrospectively analyzed a cohort of 99 patients who underwent treatment with anti-PD-1 or anti-CTLA-4 antibodies (or both) for stage IV HNSCC between 2014 and 2020 at the Johns Hopkins Hospital. Patient demographics and clinical characteristics were retrieved from electronic medical records. Baseline prognostic nutritional index (PNI) scores and pretreatment body mass index (BMI) trends were calculated. Associations between PNI and BMI were correlated with overall survival (OS), progression-free survival (PFS), and immunotherapy response. In univariate analysis, there was a significant correlation between OS and PFS with baseline PNI (OS: HR: 0.464; 95% CI: 0.265–0.814; PFS: p = 0.007 and HR: 0.525; 95% CI: 0.341–0.808; p = 0.003). Poor OS was also associated with a greater decrease in pretreatment BMI trend (HR: 0.42; 95% CI: 0.229–0.77; p = 0.005). In multivariate analysis, baseline PNI but not BMI trend was significantly associated with OS and PFS (OS: log (HR) = −0.79, CI: −1.6, −0.03, p = 0.041; PFS: log (HR) = −0.78, CI: −1.4, −0.18, p = 0.011). In conclusion, poor pretreatment nutritional status is associated with negative post-immunotherapy outcomes.

Original languageEnglish (US)
Article number5772
Issue number22
StatePublished - Nov 1 2021


  • Body mass index
  • Head and neck cancer
  • Immunotherapy
  • Nutritional status
  • Oncology
  • Prognostic nutritional index

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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