Mediterranean Diet and Immune Checkpoint Blockade Outcomes in Advanced Melanoma

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In the PRIMM study reported in JAMA Oncology, Bolte et al found that consumption of a Mediterranean diet was associated with a high probability of objective response and 12-month progression-free survival among patients receiving immune checkpoint blockade treatment for advanced melanoma.

As stated by the investigators, “Nutrition, through its association with the immune system and gut microbiome, is a poorly explored but appealing target with potential to improve the efficacy and tolerability of immune checkpoint blockade.”

Study Details

The multicenter trial included 91 immune checkpoint blockade–naive patients from the UK (n = 47) and the Netherlands (n = 44) who received immune checkpoint blockade between 2018 and 2021. Treatment consisted of a PD-1 inhibitor, a CTLA-4 inhibitor, or both.

Dietary intake was assessed through food frequency questionnaires before treatment. Patients were scored 1 through 5 (5 = highest) using the alternate Mediterranean diet score (aMED) according to habitual adherence to components of a Mediterranean dietary pattern high in whole grains, fish, nuts, fruit, and vegetables. The primary outcome measures were objective response and 12-month progression-free survival.

Key Findings

A positive linear association between aMED score and probability of objective response and 12-month progression-free survival was observed. Among patients with the highest aMED score of 5, the probability was 0.77 for objective response (P = .02) and 0.74 for 12-month progression-free survival (P = .01).

The log odds of achieving objective response increased by 1.43 for every unit increase in aMED score. The receiver operating characteristic area under the curve value for prediction of objective response and 12-month progression-free survival with aMED score was 0.70.

The investigators concluded, “This cohort study found a positive association between a Mediterranean diet, a widely recommended model of healthy eating, and response to treatment with immune checkpoint blockade. Large prospective studies from different geographies are needed to confirm the findings and further elucidate the role of diet in the context of immune checkpoint blockade.”

Rinse Weersma, MD, PhD, of the Department of Gastroenterology and Hepatology, University of Groningen and University Medical Centre Groningen, the Netherlands, is the corresponding author for the JAMA Oncology article.  

Disclosure: The study was supported by the Seerave Foundation and Dutch Cancer Society. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.