Antibiotic use reduces the efficacy of immune checkpoint inhibitors in patients with urothelial carcinoma: A systematic review and meta-analysis

被引：4

作者：

Febriyanto, Toni ^{[1
]}

Muhammad, Fajar ^{[2
]}

Wijaya, Wynne ^{[3
]}

Oey, Oliver ^{[4
,5
]}

Simadibrata, Daniel Martin ^{[6
,7
]}

机构：

[1] Dept Primary Hlth Care & Family Med, Mediway Clin, Tanjung Balai, Karimun, Indonesia

[2] Kuala Kurun Reg Hosp, Dept Emergency, Kuala Kurun, Cent Kalimantan, Indonesia

[3] Univ Gadjah Mada, Dept Internal Med, Fac Med Publ Hlth & Nursing, Yogyakarta, Indonesia

[4] Sir Charles Gairdner Hosp, Dept Med Oncol, Perth, Australia

[5] Univ Western Australia, Fac Med, Perth, WA, Australia

[6] Mayo Clin, Div Gastroenterol & Hepatol, Rochester, MN 55905 USA

[7] Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England

来源：

UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS | 2024年 / 42卷 / 05期

关键词：

Urothelial carcinoma; Immune checkpoint inhibitor; Antibiotics; Survival; Meta-analysis; CLINICAL-OUTCOMES; GUT MICROBIOME; CANCER; IMPACT; PEMBROLIZUMAB; IMMUNOTHERAPY; SURVIVAL; THERAPY;

D O I：

10.1016/j.urolonc.2023.11.017

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Context: Antibiotics have been suggested to diminish the efficacy of immune checkpoint inhibitors (ICIs) by alterations of the gut microbiota. Objective: To perform a meta -analysis summarizing the effect of antibiotics on the overall survival (OS) and progression-free survival (PFS) of urothelial cancer (UC) patients receiving ICI. Evidence acquisition: PubMed, EMBASE (Ovid), and the Cochrane Library were searched to identify studies published up to July 14, 2023. Studies reporting the associations between antibiotics use and OS and PFS in UC patients treated with ICI were included in this systematic review and meta -analysis. The random -effect model was used to pool the Hazard Ratios (HRs) for OS and PFS with 95% confidence interval (95%CI). The ROBINS-I was used to assess the risk of bias in the included studies, while the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to inform the quality of evidence. Evidence synthesis: Thirteen nonrandomized studies involving a total of 5,095 ICI -treated UC patients were included in this review, of which 1434 (28%) received antibiotics. Overall, compared to patients who did not receive antibiotics, the pooled HRs for OS and PFS in those who received antibiotics were 1.45 [95% CI 1.25-1.68] and 1.40 [95% CI 1.05-1.87], respectively. Subgroup analysis revealed that the types of ICI and timing of antibiotic initiation did not influence the effect of antibiotics on OS and PFS in UC patients (P > 0.05). Conclusions: Antibiotic use significantly reduced OS and PFS in UC patients receiving ICI. While antibiotics remain crucial for the treatment of infections in UC patients, antibiotics should be prescribed cautiously in UC patients receiving ICI. Patient summary: Antibiotic use is associated with worsened survival in UC patients receiving immune checkpoint inhibitors. (c) 2023 Elsevier Inc. All rights reserved.

引用

页码：160.e11 / 160.e23

页数：13

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