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Sarcoma

E435: Social Vulnerability Index Correlates with Gut Microbiome Diversity and Predicts Survival in Advanced Melanoma and Sarcoma Patients treated with Immune Checkpoint Blockade

Introduction: The association of fiber intake with a more favorable gut microbiome and improved pathologic response to immune checkpoint blockade (ICB) has been well defined in melanoma patients. We hypothesize that factors such as low access to high quality foods or high social vulnerability index (SVI; defined as a population’s susceptibility score regarding ability to withstand hazards such as disease, injury, or natural disasters) directly limit adequate dietary fiber intake, thus negatively affecting response to ICB. This study aims to identify the associations between SVI, food access, and dietary fiber intake in patients treated with immune checkpoint blockers.

Methods: Review of two prospectively-maintained databases from a randomized clinical trial (sarcoma patients) and a prospective observational study (melanoma patients) was performed to identify patients who were treated with ICB and had dietary data recorded. Twenty-five soft-tissue sarcoma and 128 melanoma patients were identified. Patients’ geographic information was reviewed, and SVI and food access status were assessed using the corresponding governmental calculators.

Results: Median SVI percentile among our cohort was moderate (median 0.44, interquartile range [IQR] 0.19-0.67, low vs. high cutoff 0.50), however, overall fiber intake (median 17.26 g/day, IQR 15.27-20.41, low vs. high cutoff 20 g/day) was low.  A significant inverse correlation was demonstrated between increasing SVI and fiber intake (r: -0.1755, p=0.0306). Mean overall survival was lower in high SVI melanoma patients receiving neoadjuvant ICB than those with low SVI (284 vs 423 months, p=0.061). Ninety-seven (63.4%) patients in the cohort qualified as having low access. Low access was inversely correlated with fiber intake (r: -0.1019, p=0.2115), though this observation did not reach statistical significance.

Conclusions: This early data supports our hypothesis that higher social vulnerability is associated with inadequate dietary fiber intake. Future studies are necessary to evaluate the effect of high SVI on the gut microbiome composition and the subsequent impact on clinicopathologic response to ICB. 

Learning Objectives:

  • To define social vulnerability.
  • To describe the association between social vulnerability and dietary fiber intake.
  • To describe the potential impact of higher social vulnerability on overall survival.