The Prognostic Role of High Blood Cholesterol in Advanced Cancer Patients Treated With Immune Checkpoint Inhibitors.

The Prognostic Role of High Blood Cholesterol in Advanced Cancer Patients Treated With Immune Checkpoint Inhibitors.

Publication date: May 12, 2020

Immune checkpoint inhibitors (ICI) have improved survival in numerous types of cancer. However, a great number of unselected patients still do not respond to ICI. Moreover, there is a need to identify biomarkers that could predict the prognosis of immunotherapy-treated patients. The aim of our study is to evaluate the prognostic value of baseline plasmatic cholesterol levels in metastatic cancer patients treated with immunotherapy. We retrospectively enrolled advanced cancer patients consecutively treated with ICI at our center between October 2013 and October 2018 to correlate the blood cholesterol level before treatment with overall survival (OS, primary endpoint). The secondary endpoints were the correlation between baseline cholesterol and progression-free survival (PFS), objective response rate, and toxicity (immune-related adverse events). Among 187 patients with availability of baseline plasmatic cholesterol, 58 had cholesterol levels >200?mg/dL. The median age was 70 years. Primary tumors were as follows: non-small cell lung cancer (70.0%), melanoma (15.0%), renal cell carcinoma (9.1%), urothelial cancer (4.6%), head-neck carcinoma (0.9%), and others (0.4%). The median follow-up was 21.3 months. Both OS and PFS were better in patients with high plasmatic cholesterol levels: the median OS was 19.4 versus 5.5 months (P=0.001) and the median PFS was 6.1 versus 2.4 months (P=0.002). The multivariate analysis confirmed the prognostic role of hypercholesterolemia in terms of OS, but not PFS. Hypercholesterolemia was associated with better outcomes in ICI-treated cancer patients and, as an expression of low-grade inflammation state, it could identify tumors more likely to be responsive to immunotherapy.

Concepts Keywords
Biomarkers Sterols
Cancer Cholesterol
Carcinoma Cholestanes
Cholesterol Kidney cancer
Correlation Articles
Hypercholesterolemia Health
ICI Immunotherapy
Immunotherapy Renal carcinoma
Inflammation OS PFS Hypercholesterolemia
Lung Carcinoma
Melanoma Melanoma
Metastatic Clinical endpoint
Multivariate Lipids
Primary Endpoint Hypercholesterolemia
Prognosis Renal cell carcinoma
Renal Carcinoma Lung cancer


Type Source Name
drug DRUGBANK Cholesterol
disease MESH Cancer
disease MESH non-small cell lung cancer
pathway KEGG Non-small cell lung cancer
disease MESH melanoma
pathway KEGG Melanoma
disease MESH renal cell carcinoma
pathway KEGG Renal cell carcinoma
disease MESH carcinoma
drug DRUGBANK Tropicamide
disease MESH hypercholesterolemia
disease MESH inflammation

Original Article

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