Lack of Association Between Glucose Homeostasis and Immune Checkpoint Inhibitor Outcomes: A Retrospective Institutional Review

TL;DR

This study found no link between blood glucose levels and how well patients with melanoma respond to immunotherapy treatments.

Contribution

The study shows that glucose homeostasis does not affect immunotherapy outcomes in melanoma patients.

Findings

Blood glucose levels were not associated with response, progression-free survival, or toxicity in melanoma patients on immunotherapy.

Diabetes mellitus was linked to improved overall survival, though not significantly affecting response or toxicity.

Abstract

Because immune checkpoint inhibitors (ICIs) drastically improved outcomes for patients with melanoma, it is important to understand factors that may influence patients’ response to therapy. The goal of our retrospective study was to evaluate the relationship between blood glucose levels and outcome in adult patients with melanoma on immunotherapy. In this population, we determined that blood glucose homeostasis does not associate with patient response, disease progression, or the presence of immune-related adverse events. This may influence the monitoring and management of blood glucose values in patients with melanoma on immunotherapy.

Background/Objectives: Immune checkpoint inhibitors (ICIs) have revolutionized outcomes for patients with melanoma. As such, it is important to understand factors that may influence response as well as toxicity to these therapies. Impaired glucose control is often a sign of pathologic inflammation and may alter immune system regulation, but it is unclear whether glucose control impacts patients with melanoma on ICIs. Methods: After reviewing patients with melanoma treated with ICIs at our institution between 2014 and 2024, we assessed whether longitudinal glucose control is associated with patient outcomes (response, progression-free survival, overall survival, and treatment toxicity) during ICI therapy. Results: There was no significant difference in baseline glucose values between responders and non-responders (102.5 vs. 106.0, p = 0.093). Having a baseline glucose over 200 or any glucose over 200 was not significantly associated with response (p = 0.79, p = 0.20), progression-free survival (p = 0.64, p = 0.45), overall survival (p = 0.56, p = 0.36), or toxicity (p = 0.29, p = 0.11). Although a diagnosis of diabetes mellitus was not significantly associated with response (p = 0.84), progression-free survival (p = 0.12), or toxicity (p = 0.11), it was associated with improved overall survival (p = 0.0034) in the small number of patients with diabetes. Conclusions: Overall, we observed that glucose control was not strongly associated with efficacy or toxicity in patients treated with ICIs.

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