Impact of Antibiotic Exposure Before ICIs on Cancer Survival
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Impact of Antibiotic Exposure Before Immune Checkpoint Inhibitor Treatment on Overall Survival in Older Adults With Cancer

A Population-Based Study

Lawson Eng, MD, SM; Rinku Sutradhar, PhD; Yue Niu, MSc; Ning Liu, PhD; Ying Liu, MSc; Yosuf Kaliwal, MSc; Melanie L. Powis, MSc; Geoffrey Liu, MD, MSc; Jeffrey M. Peppercorn, MD, MPH; Philippe L. Bedard, MD; Monika K. Krzyzanowska, MD, MPH

Disclosures

J Clin Oncol. 2023;41(17):3122-3134. 

In This Article

Abstract and Introduction

Abstract

Purpose: Antibiotic exposure before immune checkpoint inhibitor (ICI) treatment can negatively affect outcomes through alteration in the gut microbiome, but large-scale evaluations are lacking. We performed a population-level retrospective cohort study to evaluate the impact of antibiotic exposure before starting ICI on overall survival (OS).

Patient and Methods: Patients with cancer, age 65 years or older, who initiated treatment with ICIs between June 2012 and October 2018 in Ontario, Canada, were identified using systemic therapy administration data. The cohort was deterministically linked to other health care databases to obtain covariates and antibiotic prescription claim data at both 1 year and 60 days before ICI therapy. Multivariable Cox models evaluated the association between exposure and OS.

Results: Among the 2,737 patients with cancer who received ICIs, 59% and 19% of patients received antibiotics 1 year and 60 days before ICI therapy, respectively. Median OS was 306 days. Any antibiotic exposure within 1 year before ICI was associated with worse OS (adjusted hazard ratio [aHR], 1.12; 95% CI, 1.12 to 1.23; P = .03). In antibiotic class analysis, exposure to fluoroquinolones within 1 year (aHR, 1.26; 95% CI, 1.13 to 1.40; P< .001) or 60 days before ICI (aHR, 1.20; 95% CI, 0.99 to 1.45;

*Relevance section written by JCO Associate Editor Stephanie B. Wheeler, PhD, MPH.

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