Antibiotic Usage Reduced Overall Survival by over 70% in Non-small Cell Lung Cancer Patients on Anti-PD-1 Immunotherapy
Kazuyuki Hamada, Kiyoshi Yoshimura, Yuya Hirasawa, Masahiro Hosonuma, Masakazu Murayama, Yoichiro Narikawa, Hirotsugu Ariizumi, Ryotaro Ohkuma, Midori Shida, Yutaro Kubota, Satoshi Matsukuma, Tomoyuki Ishiguro, Takehiko Sambe, Atsushi Horiike, Atsuo Kuramasu, Satoshi Wada, Junji Tsurutani, Eisuke Inoue, Naoki Uchida, Yuji Kiuchi, Shinichi Kobayashi, Robert M. Hoffman, Takuya Tsunoda
Abstract
BACKGROUND/AIM: There is an increasing use of immunotherapy for non-small cell lung cancer (NSCLC) patients. The present study analysed the effect of antibiotic use on the outcome of NSCLC patients undergoing treatment with anti-programmed cell death-1 (anti-PD-1) immunotherapy. PATIENTS AND METHODS: This was a retrospective study of 69 NSCLC patients. Eighteen out of 69 patients received antibiotics within 21 days before or within 21 days after start of anti-PD-1 therapy. RESULTS: Patients treated with anti-PD-1 antibodies receiving antibiotics had greatly decreased objective response rate (ORR), overall survival (OS) and progression-free survival (PFS) compared to those who did not use antibiotics. Multivariate analysis showed that antibiotic treatment of patients on anti-PD-1 antibody therapy was an independent negative predictive factor of PFS; however, it was not a significant independent predictive factor of OS. CONCLUSION: Use of antibiotics within 21 days before and after anti-PD-1 treatment initiation in patients with NSCLC strongly reduced OS and PFS, suggesting the two treatments should not be combined.