Does Prior Antibiotic Use Affect Treatment Outcomes in Lung Cancer?
Posted: Monday, August 6, 2018
The use of antibiotics for unrelated infections might reduce the clinical benefit of immune checkpoint inhibitors in patients with non–small cell lung cancer (NSCLS), according to a study published in the Annals of Internal Medicine by Lisa Derosa, MD, of Gustave Roussy Cancer Campus, Villejuif, France, and colleagues. They found that 52% of patients with NSCLC taking antibiotics had an increased risk of primary progressive disease, compared with 43% of those not taking antibiotics.
The study included 239 patients with NSCLC being treated with anti–PD-L1 monoclonal antibody monotherapy or combination at 2 academic institutions. A total of 48 patients had taken antibiotics, most commonly β-lactam or quinolones for pneumonia and urinary tract infections, within 30 days of starting immune checkpoint inhibitor treatment.
In addition to an increased risk of primary progressive disease, patients who had previously used antibiotics had a shorter progression-free survival and overall survival than did patients who had not taken antibiotics within 30 days of treatment. The median progression-free survival was 1.9 months compared with 3.8 months, and the median overall survival was 7.9 months compared with 24.6 months.
Dr. Derosa and colleagues proposed that the impact of antibiotics on the gut microbiota might be affecting the efficacy of the immune checkpoint inhibitor treatment. They also suggested that an intact gut microbiota is needed to mobilize the immune system and that modulation of antibiotic dysbiosis and gut microbiome composition might improve the clinical results of immune checkpoint inhibitors.
“The data in this report may add additional incentive to avoid unnecessary [antibiotic use],” the authors concluded, although further study in large prospective trials is needed to confirm these findings.