Association of Antibiotic Exposure With Survival and Toxicity in Patients With Melanoma Receiving Immunotherapy
| Autor: | Jacob E. Shabason, Cathy Zheng, Alexander Lin, Jahan J. Mohiuddin, Andrea Facciabene, Amit Maity, Alexander C. Huang, Wei Xu, John N. Lukens, Emily J. Anstadt, Samuel Swisher-McClure, Tara C. Mitchell, Brian Chu, Abigail Doucette, Lynn M. Schuchter, Xingmei Wang, Kendra Poirier, Giorgos C. Karakousis, Ravi K. Amaravadi |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Adolescent medicine.drug_class Antibiotics Disease-Free Survival Young Adult 03 medical and health sciences Antineoplastic Agents Immunological 0302 clinical medicine Internal medicine Humans Immunologic Factors Medicine Colitis Immune Checkpoint Inhibitors Melanoma Aged Neoplasm Staging 030304 developmental biology Aged 80 and over 0303 health sciences Proportional hazards model business.industry Incidence (epidemiology) Hazard ratio Genetic Variation Cancer Articles Middle Aged medicine.disease Confidence interval Anti-Bacterial Agents Gastrointestinal Microbiome Oncology 030220 oncology & carcinogenesis Toxicity Female Immunotherapy business |
| Zdroj: | J Natl Cancer Inst |
| ISSN: | 1460-2105 0027-8874 |
| DOI: | 10.1093/jnci/djaa057 |
| Popis: | Background Gut microbial diversity is associated with improved response to immune checkpoint inhibitors (ICI). Based on the known detrimental impact that antibiotics have on microbiome diversity, we hypothesized that antibiotic receipt prior to ICI would be associated with decreased survival. Methods Patients with stage III and IV melanoma treated with ICI between 2008 and 2019 were selected from an institutional database. A window of antibiotic receipt within 3 months prior to the first infusion of ICI was prespecified. The primary outcome was overall survival (OS), and secondary outcomes were melanoma-specific mortality and immune-mediated colitis requiring intravenous steroids. All statistical tests were two-sided. Results There were 568 patients in our database of which 114 received antibiotics prior to ICI. Of the patients, 35.9% had stage III disease. On multivariable Cox proportional hazards analysis of patients with stage IV disease, the antibiotic-exposed group had statistically significantly worse OS (hazard ratio [HR] = 1.81, 95% confidence interval [CI] = 1.27 to 2.57; P Conclusion Patients with stage III and IV melanoma exposed to antibiotics prior to ICI had statistically significantly worse OS than unexposed patients. Antibiotic exposure was associated with greater incidence of moderate to severe immune-mediated colitis. Given the large number of antibiotics prescribed annually, physicians should be judicious with their use in cancer populations likely to receive ICI. |
| Databáze: | OpenAIRE |
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