The impact of antibiotic and proton pump inhibitor use at the time of adjuvant platinum-based chemotherapy on survival in patients with endometrial cancer

• Published in: Gynecologic oncology Vol. 178; pp. 14 - 22
• Main Authors: Haight, Paulina J., Kistenfeger, Quinn, Riedinger, Courtney J., Khadraoui, Wafa, Backes, Floor J., Bixel, Kristin L., Copeland, Larry J., Cohn, David E., Cosgrove, Casey M., O'Malley, David M., Nagel, Christa I., Spakowicz, Daniel J., Chambers, Laura M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2023
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Chemotherapy, Adjuvant; Cohort Studies; Endometrial cancer; Endometrial Neoplasms - pathology; Female; Humans; Neoplasm Staging; Platinum - therapeutic use; Platinum-based chemotherapy; Proton Pump Inhibitors - therapeutic use; Proton-pump inhibitor; Retrospective Studies; Antibiotics; Endometrial cancer; Platinum-based chemotherapy; Proton-pump inhibitor
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2023.09.005

We sought to assess the impact of antibiotic (ABX) and proton-pump inhibitor (PPI) use on progression-free (PFS) and overall survival (OS) in patients treated with adjuvant platinum-based chemotherapy (PC) for endometrial cancer (EC).
A retrospective, single-institution cohort study of EC patients treated with ≥four cycles of adjuvant PC following surgical staging from 2014 to 2020. Demographics and clinicopathologic features, including ABX and PPI use, were compared using χ2 and Fisher's exact tests. Univariate and multivariable analyses were performed, and survival outcomes were compared using the log-rank test.
Of 325 patients, 95 (29%) received ABX, and 80 (24.6%) received PPI. ABX were associated with decreased 3-year PFS (49.9% vs. 66%; p = 0.0237) but not 3-year OS (68.9% vs. 79.9%; p = 0.0649). ABX targeting gram-positive bacteria were associated with decreased 3-year PFS (21.2% vs. 66.0% vs. 55.4%; p = 0.0038) and 3-year OS (36.5% vs. 79.9% vs. 75.6%; p = 0.0014) compared to no ABX and other ABX, respectively. PPI use was associated with decreased 3-year PFS (46.9% vs. 66.0%; p = 0.0001) and 3-year OS (60.7% vs. 81.9%; p = 0.0041) compared to no PPI. On multivariable regression analysis controlling for confounders including stage, histology, grade, radiation, and co-morbidities, PPI use was independently associated with worse PFS (HR 1.96, 95% CI 1.25–3.08; p = 0.0041) and OS (HR 2.06, 95% CI 1.01–4.18, p = 0.04).
In this retrospective cohort study, we demonstrate that PPI use is independently associated with worse PFS and OS in patients with EC treated with PC. ABX use was associated with worse PFS on univariate analysis only. There is an unmet need to understand how PPI, ABX, and, potentially, the microbiome impact the effectiveness of chemotherapy in EC patients.
•Many patients will use antibiotics and/or a proton pump inhibitor at time of adjuvant therapy for endometrial cancer.•PPI use at time of adjuvant platinum-based chemotherapy is independently associated with worse outcomes.•Antibiotic use at time of adjuvant platinum-based chemotherapy was associated with worse survival on univariate analysis.