Prior antibiotic use associated with worse outcomes in patients being treated with checkpoint inhibitors

[Lamount]

Association of Prior Antibiotic Treatment With Survival and Response to Immune Checkpoint Inhibitor Therapy in Patients With Cancer

This cohort study assesses the clinical outcomes of patients with cancer treated with immune checkpoint inhibitors (ICIs) who received concurrent or prior broad-spectrum antibiotic treatment to determine whether an association exists between antibiotic therapy and overall survival and response to...

jamanetwork.com

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[Palex80]

Interesting. There are some data on intestine flora and immune ckeckpoint inhibitors.

The gut microbiome and response to immune checkpoint inhibitors: preclinical and clinical strategies

There is growing interest in identifying predictive biomarkers for inhibitors of programmed cell death protein 1 receptor (PD-1), programmed death ligand 1 (PD-L1), and cytotoxic T-lymphocyte associated protein 4 (CTLA-4). Given the links between the ...

www.ncbi.nlm.nih.gov

and I have seen a number of running clinical trials with checkpoint inhibitors where the protocol asks for stool samples to be collected. So perhaps we will get to the root of this at some point.

White blook cell counts have also been linked to response to checkpoint inhibitors.

Peripheral blood biomarkers correlate with outcomes in advanced non-small cell lung Cancer patients treated with anti-PD-1 antibodies

Anti-programmed cell death 1 (PD-1) antibodies have demonstrated improved overall survival (OS) and progression-free survival (PFS) in a subset of patients with metastatic or locally advanced non-small cell lung cancer (NSCLC). To date, no blood biomarkers ...

www.ncbi.nlm.nih.gov

The potential bias is huge in observatory studies like these. For example: Patients who need antibiotics are more sick than those who don't need any...
The use of antibiotics doesn't have to do anything with the efficacy of checkpoint inhibitors itself, it can merely be a surrogate marker for patients in good or not so good health status.

I find it highly questionable why an article such as this gets published in Jama Oncology (IF: 22)...

 

[medgator]

Gut Flora/microbiome continues to be important for yet another reason

 

[evilbooyaa]

Palex is spot on. There is some stuff about gut microbiome influencing ICI outcomes, but patients on antibiotics may just have been sicker overall. Did they account for differences in amount of ICI given and deviations from schedule (say due to Abx use or hospitalization)?