{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:14:23Z","timestamp":1783350863896,"version":"3.54.6"},"reference-count":47,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"London Regional Cancer Program\u2019s Catalyst Grants Program"},{"name":"Keith Samitt Translational Research Grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Melanoma remains a major global health burden, though immunotherapy and targeted therapy have markedly improved survival. Obesity has paradoxically been associated with favorable outcomes in melanoma, yet body mass index (BMI) alone fails to capture its influence on treatment response. To address this gap, we conducted a multi-site cohort study within the Canadian Melanoma Research Network, including patients with advanced melanoma treated with immunotherapy or targeted therapy. Body composition was quantified using computerized tomography (CT) imaging to assess visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), skeletal muscle (SM) mass and intermuscular adipose tissue (IMAT), and associations with progression-free survival (PFS) and overall survival (OS) were evaluated. No overall association was seen for BMI, SAT, VAT, IMAT or SM with PFS or OS. In the targeted therapy subset, higher BMI, SAT, VAT and SM were associated with better OS (hazard ratios 0.56 to 0.65), while no effect was seen in the immunotherapy group. IMAT emerged as a novel prognostic marker, with elevated levels associated with lower OS in males and better OS in females. Our findings show that CT-based body composition is not associated with survival outcomes in patients with advanced melanoma receiving immunotherapy.<\/jats:p>","DOI":"10.3390\/curroncol33070403","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:01:37Z","timestamp":1783339297000},"page":"403","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Body Composition and Melanoma Outcomes in Patients on Immunotherapy or Targeted Therapy: An Analysis from Canadian Melanoma Research Network"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7858-1330","authenticated-orcid":false,"given":"Mohammad","family":"Biglari","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, University of Western Ontario, London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanji","family":"Ali","sequence":"additional","affiliation":[{"name":"Medical Oncologist, BC Cancer Abbotsford Center, Abbotsford, BC V2S 1J8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago","family":"Muniz","sequence":"additional","affiliation":[{"name":"Princess Margaret Cancer Center, Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9840-7057","authenticated-orcid":false,"given":"Marcus","family":"Butler","sequence":"additional","affiliation":[{"name":"Princess Margaret Cancer Center, Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marguerite","family":"Ennis","sequence":"additional","affiliation":[{"name":"Applied Statistician, Markham, ON L3R 6H9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Ernst","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University of Western Ontario, London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Elisa","family":"Lohmann","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University of Western Ontario, London, ON N6A 3K7, Canada"},{"name":"Department of Epidemiology, University of Western Ontario, London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1001\/jamadermatol.2022.0160","article-title":"Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040","volume":"158","author":"Arnold","year":"2022","journal-title":"JAMA Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E615","DOI":"10.1503\/cmaj.240095","article-title":"Projected estimates of cancer in Canada in 2024","volume":"196","author":"Brenner","year":"2024","journal-title":"Can. Med. Assoc. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"104276","DOI":"10.1016\/j.critrevonc.2024.104276","article-title":"The treatment of advanced melanoma: Current approaches and new challenges","volume":"196","author":"Boutros","year":"2024","journal-title":"Crit. Rev. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1016\/S1470-2045(18)30700-9","article-title":"Nivolumab plus ipilimumab or nivolumab alone versus ipilimumab alone in advanced melanoma (CheckMate 067): 4-year outcomes of a multicentre, randomised, phase 3 trial","volume":"19","author":"Hodi","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ejca.2017.07.022","article-title":"Final analysis of a randomised trial comparing pembrolizumab versus investigator-choice chemotherapy for ipilimumab-refractory advanced melanoma","volume":"86","author":"Hamid","year":"2017","journal-title":"Eur. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3998","DOI":"10.1200\/JCO.22.01599","article-title":"Seven-Year Follow-Up of the Phase III KEYNOTE-006 Study: Pembrolizumab Versus Ipilimumab in Advanced Melanoma","volume":"41","author":"Robert","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1038\/nrm1498","article-title":"The RAF proteins take centre stage","volume":"5","author":"Wellbrock","year":"2004","journal-title":"Nat. Rev. Mol. Cell Biol."},{"key":"ref_8","unstructured":"Cancer Genome Atlas Network (2015). Genomic Classification of Cutaneous Melanoma. Cell, 161, 1681\u20131696."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1016\/S1470-2045(16)30122-X","article-title":"Cobimetinib combined with vemurafenib in advanced BRAFV600-mutant melanoma (coBRIM): Updated efficacy results from a randomised, double-blind, phase 3 trial","volume":"17","author":"Ascierto","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/S0140-6736(15)60898-4","article-title":"Dabrafenib and trametinib versus dabrafenib and placebo for Val600 BRAF-mutant melanoma: A multicentre, double-blind, phase 3 randomised controlled trial","volume":"386","author":"Long","year":"2015","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1038\/nature00766","article-title":"Mutations of the BRAF gene in human cancer","volume":"417","author":"Davies","year":"2002","journal-title":"Nature"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"680536","DOI":"10.5402\/2013\/680536","article-title":"The Association between Obesity and Cancer Risk: A Meta-Analysis of Observational Studies from 1985 to 2011","volume":"2013","author":"Dobbins","year":"2013","journal-title":"ISRN Prev. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2412","DOI":"10.1158\/1055-9965.EPI-13-0647","article-title":"Lower Skin Cancer Risk in Women with Higher Body Mass Index: The Women\u2019s Health Initiative Observational Study","volume":"22","author":"Tang","year":"2013","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.ejca.2012.08.028","article-title":"Obesity and risk of malignant melanoma: A meta-analysis of cohort and case\u2013control studies","volume":"49","author":"Sergentanis","year":"2013","journal-title":"Eur. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1038\/s41591-018-0221-5","article-title":"Paradoxical effects of obesity on T cell function during tumor progression and PD-1 checkpoint blockade","volume":"25","author":"Wang","year":"2018","journal-title":"Nat. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S1470-2045(18)30078-0","article-title":"Association of body-mass index and outcomes in patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy: A retrospective, multicohort analysis","volume":"19","author":"McQuade","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1158\/0008-5472.CAN-17-3287","article-title":"The Importance of Body Composition in Explaining the Overweight Paradox in Cancer\u2014Counterpoint","volume":"78","author":"Caan","year":"2018","journal-title":"Cancer Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1758-5996-3-12","article-title":"Visceral adiposity, insulin resistance and cancer risk","volume":"3","author":"Donohoe","year":"2011","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1146\/annurev-med-051613-012328","article-title":"Impact of the Obesity Epidemic on Cancer","volume":"66","author":"Goodwin","year":"2015","journal-title":"Annu. Rev. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.metabol.2018.11.001","article-title":"Obesity and cancer risk: Emerging biological mechanisms and perspectives","volume":"92","author":"Avgerinos","year":"2019","journal-title":"Metabolism"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1055\/s-2007-979879","article-title":"Difference in Leptin mRNA Levels Between Omental and Subcutaneous Abdominal Adipose Tissue from Obese Humans","volume":"28","author":"Hube","year":"1996","journal-title":"Horm. Metab. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1038\/sj.ijo.0801385","article-title":"Leptin plasma concentrations are dependent on body fat distribution in obese patients","volume":"24","author":"Minocci","year":"2000","journal-title":"Int. J. Obes."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"913","DOI":"10.2337\/diabetes.47.6.913","article-title":"Leptin secretion from subcutaneous and visceral adipose tissue in women","volume":"47","author":"Reynisdottir","year":"1998","journal-title":"Diabetes"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"R365","DOI":"10.1530\/ERC-15-0400","article-title":"Obesity and cancer: Mechanistic insights from transdisciplinary studies","volume":"22","author":"Allott","year":"2015","journal-title":"Endocr.-Relat. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.amjsurg.2022.03.025","article-title":"Validation of automated body composition analysis using diagnostic computed tomography imaging in patients with pancreatic cancer","volume":"224","author":"Gunesch","year":"2022","journal-title":"Am. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1017\/S0007114521001446","article-title":"The use of alternate vertebral levels to L3 in computed tomography scans for skeletal muscle mass evaluation and sarcopenia assessment in patients with cancer: A systematic review","volume":"127","author":"Vangelov","year":"2022","journal-title":"Br. J. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"11369","DOI":"10.1038\/s41598-018-29825-5","article-title":"Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population","volume":"8","author":"Derstine","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.clnesp.2024.07.1054","article-title":"Validation of an automated segmentation method for body composition analysis in colorectal cancer patients using diagnostic abdominal computed tomography images","volume":"63","author":"Querido","year":"2024","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ejca.2022.10.013","article-title":"Protective effect of obesity on survival in cancers treated with immunotherapy vanishes when controlling for type of cancer, weight loss and reduced skeletal muscle","volume":"178","author":"Antoun","year":"2022","journal-title":"Eur. J. Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.annonc.2020.12.012","article-title":"Relevance of body mass index as a predictor of systemic therapy outcomes in metastatic melanoma: Analysis of the MelBase French cohort data\u2606","volume":"32","author":"Dalle","year":"2021","journal-title":"Ann. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s40425-019-0512-5","article-title":"Complex inter-relationship of body mass index, gender and serum creatinine on survival: Exploring the obesity paradox in melanoma patients treated with checkpoint inhibition","volume":"7","author":"Naik","year":"2019","journal-title":"J. Immunother. Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1186\/s12935-024-03532-w","article-title":"A multidimensional analysis of the impact of obesity on immune checkpoint inhibitor therapy efficacy","volume":"24","author":"Xu","year":"2024","journal-title":"Cancer Cell Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e151347","DOI":"10.1172\/JCI151347","article-title":"Inhibition of estrogen signaling in myeloid cells increases tumor immunity in melanoma","volume":"131","author":"Chakraborty","year":"2021","journal-title":"J. Clin. Investig."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3233\/KCA-180047","article-title":"Targeted Therapy and Immunotherapy: Effect of Body Mass Index on Clinical Outcomes in Patients Diagnosed with Metastatic Renal Cell Carcinoma","volume":"3","author":"Bergerot","year":"2019","journal-title":"Kidney Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.semcancer.2023.07.004","article-title":"Multifaceted effects of obesity on cancer immunotherapies: Bridging preclinical models and clinical data","volume":"95","author":"Vick","year":"2023","journal-title":"Semin. Cancer Biol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Loosen, S.H., Bosch, V.v.D., Gorgulho, J., Schulze-Hagen, M., Kandler, J., J\u00f6rdens, M.S., Tacke, F., Loberg, C., Antoch, G., and Br\u00fcmmendorf, T. (2021). Progressive Sarcopenia Correlates with Poor Response and Outcome to Immune Checkpoint Inhibitor Therapy. J. Clin. Med., 10.","DOI":"10.3390\/jcm10071361"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e001117","DOI":"10.1136\/jitc-2020-001117","article-title":"Body mass index (BMI) and outcome of metastatic melanoma patients receiving targeted therapy and immunotherapy: A multicenter international retrospective study","volume":"8","author":"Rutkowski","year":"2020","journal-title":"J. Immunother. Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e000821","DOI":"10.1136\/jitc-2020-000821","article-title":"Impact of body composition on outcomes from anti-PD1 +\/\u2212 anti-CTLA-4 treatment in melanoma","volume":"8","author":"Young","year":"2020","journal-title":"J. Immunother. Cancer"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Jansen, J., Garmyn, M., and G\u00fcven\u00e7, C. (2024). The Effect of Body Mass Index on Melanoma Biology, Immunotherapy Efficacy, and Clinical Outcomes: A Narrative Review. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25126433"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Li, Q., Dong, Y., Ma, Y., Mo, Y., Yuan, J., and Liu, X. (2024). Sex-specific difference for melanoma from immunotherapy advancement. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1484716"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"115668","DOI":"10.1016\/j.ejca.2025.115668","article-title":"Sex-specific survival in advanced metastatic melanoma\u2013a DeCOG study on 2032 patients of the multicenter prospective skin cancer registry ADOREG","volume":"227","author":"Leven","year":"2025","journal-title":"Eur. J. Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1186\/s12967-025-06507-1","article-title":"Fully volumetric body composition analysis for prognostic overall survival stratification in melanoma patients","volume":"23","author":"Borys","year":"2025","journal-title":"J. Transl. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1038\/s41574-022-00784-2","article-title":"Intermuscular adipose tissue in metabolic disease","volume":"19","author":"Goodpaster","year":"2022","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"116021","DOI":"10.1016\/j.celrep.2025.116021","article-title":"Intramuscular adipose tissue restricts functional muscle recovery","volume":"44","author":"Norris","year":"2025","journal-title":"Cell Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s10555-020-09934-2","article-title":"Interaction between adipose tissue and cancer cells: Role for cancer progression","volume":"40","author":"Dumas","year":"2020","journal-title":"Cancer Metastasis Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s10555-022-10059-x","article-title":"The adipocyte microenvironment and cancer","volume":"41","author":"Mukherjee","year":"2022","journal-title":"Cancer Metastasis Rev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"309570","DOI":"10.1155\/2014\/309570","article-title":"Intermuscular Fat: A Review of the Consequences and Causes","volume":"2014","author":"Addison","year":"2014","journal-title":"Int. J. Endocrinol."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/7\/403\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T14:16:06Z","timestamp":1783347366000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/7\/403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":47,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["curroncol33070403"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33070403","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]}}}