Antibiotic Treatment is an Independent Poor Risk Factor in NSCLC But Not in Melanoma Patients Who had Received Anti-PD-1/L1 Monotherapy

• Published in: Clinical lung cancer Vol. 24; no. 4; pp. 295 - 304
• Main Authors: Vihinen, Hannes, Jokinen, Artturi, Laajala, Teemu D., Wahid, Nesna, Peltola, Lotta, Kettunen, Tiia, Rönkä, Aino, Tiainen, Leena, Skyttä, Tanja, Kohtamäki, Laura, Tulokas, Sanni, Karhapää, Hanna, Hernberg, Micaela, Silvoniemi, Maria, Mattila, Kalle E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2023
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; B7-H1 Antigen; Carcinoma, Non-Small-Cell Lung; Humans; Immune checkpoint inhibitors; Lung Neoplasms; Melanoma - drug therapy; Overall survival; Prognostic factor; Progression-free survival; Retrospective Studies; Skin Neoplasms - drug therapy; Prognostic factor; Immune checkpoint inhibitors; Antibiotics; Overall survival; Progression-free survival
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2023.01.004

•Recent antibiotic treatment may reduce the efficacy of cancer immunotherapy by disrupting gut microbiome.•The association of antibiotic treatment and survival outcomes were retrospectively analyzed in melanoma and non–small-cell lung cancer (NSCLC) patients who had received anti-PD-1/L1 antibodies.•Antibiotic treatment was associated with inferior overall survival in melanoma and with inferior progression-free survival and overall survival in NSCLC patients.•Antibiotic treatment was an independent risk factor for inferior overall survival and progression-free survival in NSCLC but not in melanoma when accounting for other relevant prognostic factors in multivariable analysis.
Antibiotic treatment may reduce the efficacy of cancer immunotherapy by disrupting gut microbiome. We aimed to study the association of antibiotics and survival outcomes in advanced cutaneous melanoma and non–small-cell lung cancer (NSCLC) patients who had received anti-PD-1/L1 monotherapy.
A total of 222 melanoma and 199 NSCLC patients had received anti-PD-1/L1 monotherapy in 5 Finnish hospitals between January 2014 and December 2020. Clinical characteristics, antibiotic and corticosteroid treatment, and survival outcomes were retrospectively collected from hospital and national medical records.
There were 32% of melanoma and 31% of NSCLC patients who had received antibiotic treatment (ABT) 3 months before to 1 month after the first anti-PD-1/L1 antibody infusion. In survival analyses, early antibiotic treatment was associated with inferior overall survival (OS) (ABT 19.2 [17.6-43.7] vs. no ABT 35.6 [29.3-NA] months, P = .033) but not with inferior progression-free survival (PFS) (ABT 5.8 [3.0-12.6] vs. no ABT 10.2 [7.7-15.3] months, P = .3) in melanoma patients and with inferior OS (ABT 8.6 [6.4-12.3] vs. no ABT 18.5 [15.1-21.6] months, P < .001) and PFS (ABT 2.8 [2.1-4.5] vs. no ABT 5.6 [4.4-8.0] months, P = .0081) in NSCLC patients. In multivariable analyses, ABT was not an independent risk-factor for inferior OS and PFS in melanoma but was associated with inferior OS (hazard ratio [HR] 2.12 [1.37-3.28]) and PFS (HR 1.65 [1.10-2.47]) in NSCLC after adjusted for other risk factors.
Early ABT was an independent poor risk factor in NSCLC patients who had received anti-PD-1/L1 monotherapy but not in melanoma patients. The weight of ABT as a poor risk factor might depend on other prognostic factors in different cancers.
Recent antibiotic treatment may reduce the efficacy of cancer immunotherapy. In retrospective study of 222 melanoma and 199 non-small-cell lung cancer patients who had been treated with anti-PD-1/L1 antibodies, antibiotic treatment was an independent risk factor for inferior overall survival and progression-free survival in NSCLC but not in melanoma when accounting for other relevant prognostic factors in multivariable analysis.