Body composition and physical activity as predictors of immune-related adverse events in patients undergoing cancer immunotherapy: a systematic review

De Nys L., Güney G., Grootjans F. I., Maes Y. K., Adriaenssens N.

Expert Review of Anticancer Therapy, 2026 (SCI-Expanded, Scopus) identifier identifier

  • Publication Type: Article / Review
  • Publication Date: 2026
  • Doi Number: 10.1080/14737140.2026.2625780
  • Journal Name: Expert Review of Anticancer Therapy
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Chemical Abstracts Core, CINAHL, EMBASE, MEDLINE
  • Keywords: body composition, cancer immunotherapy toxicity, immune checkpoint inhibitors, Immune-related adverse events, physical activity, prognostic biomarkers, sarcopenia, sarcopenic obesity
  • Hacettepe University Affiliated: Yes

Abstract

Introduction: Host factors may affect immune-related adverse events (irAE) during immune checkpoint inhibitor (ICI) therapy. We systematically reviewed studies on body composition (BMI, CT/DXA-defined sarcopenia, sarcopenic obesity) and physical activity (PA) in relation to irAE incidence and severity in ICI-treated adults. Methods: PubMed, Embase, Scopus, and Web of Science were searched from inception to 15 December 2024. Eligible studies assessed baseline body composition and/or PA in relation to irAE. Risk of bias was evaluated using the NIH tool and QUIPS. Findings were synthesized using structured narrative methods. Results: Seven studies (2,590 patients) were included. Two large cohorts found overweight/obese patients had higher odds of any-grade irAE (OR = 1.4–1.5); one disease-specific cohort found no association. One CT-based study showed higher irAE risk with sarcopenia (OR = 2.64) and more with sarcopenic obesity (OR = 5.50). Two studies on PA were conflicting: one found higher PA reduced severe irAE risk (OR = 0.19), another found no association. Conclusions: Body composition and PA may help predict irAE in ICI-treated patients. Evidence is low to very low certainty: overweight/obesity may increase toxicity risk, higher PA may lower risk, and evidence for sarcopenia is limited. Standardized prospective studies are needed to confirm these associations. Protocol registration: https://www.crd.york.ac.uk/PROSPERO identifier is CRD420251084119.