Mediterranean diet correlates with response to melanoma immunotherapy

According to findings from a cohort study published in , a habitual Mediterranean diet may play a role in improving responses to immune checkpoint blockade as a treatment for advanced melanoma. JAMA Oncology.

According to a nutritionist at the University of Groningen, “Larger studies across multiple regions are needed to further elucidate the role of diet in cancer immunotherapy.

An alternative Mediterranean diet was positively associated with 12-month progression-free survival (PFS-12; probability 0.74; P. = .01; false discovery rate [FDR].021; effective degrees of freedom [edf]1.54) as well as the overall response rate (ORR; probability of 0.77; P. = .02; FDR, .032; edf, 0.83).

“Mediterranean dietary patterns are associated with positive responses to immune checkpoint blockade, a relatively new and successful treatment for severe cancers,” University of Groningen and Groningen University Medical Center, The Netherlands. said in a written comment to CancerNetwork.^®. “these are [immune checkpoint blockade] Drugs make the immune system recognize, eliminate, and destroy cancer cells. “

Borte elaborated on the potential health benefits associated with the Mediterranean diet.

“These foods are important sources of fiber, unsaturated fats, antioxidants and polyphenols. Preclinical and functional studies have shown immunomodulatory and antitumor activity of these nutrients, some of which It’s mediated through the gut microbiome,” says Bolte.

Investigators in this cohort study evaluated the association between habitual diet and response to treatment with immune checkpoint blockade for advanced melanoma. The researchers prospectively collected clinical and dietary data from patients enrolled in the PRIMM-UK trial (NCT03643289) and the PRIMM-NL/POINTING trial (NCT04193956).

Clinical endpoints of interest included ORR, 12-month PFS, and immune-related adverse reactions (IRAE). Investigators assessed IRAEs based on the CTCAE v5.0 criteria and focused on grade 2 or higher incidence to avoid individual differences associated with the mildest AEs.

Researchers assessed dietary intake through the EPIC-Norfolk food frequency questionnaire and the Dutch Healthy Diet food frequency questionnaire. Determination of diet quality across patient cohorts included four food-based scores, including the Alternative Mediterranean Diet Score, the Original Plant-Based Diet Index, the Healthy Plant-Based Diet Index, and the Unhealthy Plant-Based Diet Index. included use.

A logistic generalized additive model was used to determine whether higher adherence to a particular diet correlated with a higher likelihood of patient response or IRAE.

The study included 44 patients from the PRIMM-NL trial and 47 patients from the PRIMM-UK trial. Most patients in each cohort had previously received single-agent PD-L1 inhibition (73% vs. 51%). Most of the PRIMM-NL patients had stage M1d disease (39%) and most of the PRIMM-UK patients had stage M1c disease (36%).

In terms of diet score, the mean score is 3.07 (standard deviation [SD], 1.25) For the alternative Mediterranean diet, 30.52 (SD, 4.29) for the original plant-based diet index, 32.84 (SD, 5.81) for the healthy plant-based diet index, and 32.84 (SD, 5.81) for the unhealthy plant-based diet. For exponent 31.70 (SD, 4.56) in the PRIMM-NL population. For the PRIMM-UK population, the respective mean dietary scores were 2.55 (SD, 1.28), 34.23 (SD, 4.45), 35.49 (7.37), and 34.32 (5.65), respectively.

For alternative Mediterranean diet scores, the log odds of being a responder increased by 1.43 for each unit increase in alternative Mediterranean diet score. Training in the PRIMM-UK cohort and validation in the PRIMM-NL cohort predicted PFS at 12 months and ORR with an alternative Mediterranean diet score with an area under the curve of 0.70.

In principal component analysis, researchers noted a parabolic association of PC2 characterized by higher fruit intake in PFS at 12 months (P. = .01; FDR, .018; edf, 2.14) and ORR (P. = .01; FDR, .018; edf, 2.7) in the PRIMM-NL population. No significant association was observed within the PRIMM-UK population.

Individual components of the Mediterranean diet, including mono- and polyunsaturated fatty acids, whole grain breads, vegetables, legumes, vitamins C and E, and β-carotene, were associated with similar responses and positive responses to the Alternative Mediterranean Diet Score. there was a correlation. However, these associations lacked statistical significance after correction for multiple hypothesis testing.

The researchers noted that diets high in legumes, whole grain bread, and magnesium caused fewer IRAEs.

While citing the need for additional research to confirm the health benefits observed in her study, Borte discussed how the wider adoption of the Mediterranean diet would have a positive impact on the American patient population. Suggested to give

“The traditional principles of the Mediterranean diet are the dietary principles most recommended by public health authorities around the world. “The incidence of cancer is rising. Larger studies across multiple regions are needed to further elucidate the role of diet in cancer immunotherapy,” Bolte concluded.

reference

Borte LA, Lee KA, Björk JR, et al. Association between Mediterranean diet and outcomes in patients treated with immune checkpoint blockers for advanced melanoma. JAMA Oncol. Published online February 16, 2023. doi:10.1001/jamaoncol.2022