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We’ve previously seen data that heavier melanoma patients appear to have superior survival outcomes with immunotherapy. Does that hold true for NSCLC? This pooled analysis of over 2000 patients on 4 prospective atezolizumab trials (two of which were randomized) explores associations among BMI and survival. Among these, 49% were normal weight with the rest being overweight or obese. As before, increasing BMI was associated with an increasing survival benefit from immunotherapy. In fact, that relationship was almost linear. The BMI effect was independent of gender and mainly driven by patients with PD-L1 positive tumors. Overweight and obese patients with PD-L1 negative tumors and those who were randomized to chemotherapy did not have improved survival compared to normal weight patients. A best guess at this point is that perhaps the pro-inflammatory state of obesity creates baseline immune impairment that benefits from immunotherapy. Did they recommend patients gain weight when starting immunotherapy? No. But we should at least stratify for BMI in trials to avoid potential imbalances on the treatment effect scales. TBL: Overweight and obese patients derive a greater survival benefit from atezolizumab immunotherapy than those of normal weight. | Kichenadasse, JAMA Oncol 2019