Effects of malnutrition on cardiovascular outcomes in malignant melanoma patients treated with pembrolizumab: A global propensity score-matched cohort study.

Abstract

e21530 Background: Malnutrition is a well-recognized risk factor for poor outcomes in cancer patients. This study investigates the impact of malnutrition on overall and cardiovascular outcomes in malignant melanoma patients receiving pembrolizumab. Methods: A retrospective cohort study using a real-world global database identified malignant melanoma patients treated with pembrolizumab. Patients were stratified by malnutrition status and propensity score matched (1:1) based on age, race, and comorbidities. Follow-up extended to three years, assessing outcomes such as mortality, cardiovascular events, acute kidney injury, secondary malignancies, and hospital readmission rates. Risk ratios (RR) with 95% confidence intervals (CIs) were calculated. Results: A total of 15,049 patients with malignant melanoma were included. After PSM, each cohort comprised 3,421 patients. The most common comorbidities were diabetes and hypertension. Malnutrition was associated with significantly worse cardiovascular outcomes. The risk of mortality was substantially higher in malnourished patients (RR: 1.80, 95% CI: 1.78–2.00, p < 0.001). Malnourished patients also had a significantly increased risk of acute myocardial infarction (RR: 1.30, 95% CI: 1.09–1.64, p = 0.005) and cardiac arrest (RR: 1.50, 95% CI: 1.07–2.37, p = 0.021). While the incidence of new-onset heart failure (RR: 1.09, 95% CI: 0.67–1.23, p = 0.15) and atrial fibrillation/flutter (RR: 1.10, 95% CI: 0.99–1.23, p = 0.06) did not show a statistically significant difference, malnourished patients had a markedly higher risk of acute kidney injury (RR: 1.57, 95% CI: 1.42–1.74, p < 0.001). Other outcomes, including ischemic stroke (RR: 1.60, 95% CI: 0.88–3.15, p = 0.11), hemorrhagic stroke (RR: 1.10, 95% CI: 0.88–1.57, p = 0.28), hypothyroidism (RR: 1.06, 95% CI: 0.98–1.14, p = 0.11), and hemophagocytic lymphohistiocytosis (RR: 1.00, 95% CI: 0.41–2.39, p = 1.00), did not differ significantly between groups. Additionally, malnourished patients had a higher incidence of secondary malignancies (RR: 1.33, 95% CI: 1.24–1.54, p < 0.001) and a trend toward increased hospital readmissions (RR: 1.15, 95% CI: 0.98–1.35, p = 0.08). Conclusions: Malnutrition significantly worsens cardiovascular outcomes in malignant melanoma patients treated with pembrolizumab. These findings underscore the need for early nutritional interventions to improve patient prognosis and mitigate cardiovascular risks. Future research should explore targeted nutritional strategies to optimize outcomes in this high-risk population.