The Negative Impact of Antibiotics on Outcomes in Cancer Patients Treated With Immunotherapy

A New Independent Prognostic Factor?

A. Elkrief; L. Derosa; G. Kroemer; L. Zitvogel; B. Routy


Ann Oncol. 2019;30(10):1572-1579. 

In This Article

ATB-related Dysbiosis in the Hematopoietic Stem Cell Transplant Population

An early demonstration of the impact of ATB on immunity and cancer therapy was obtained in the allogeneic hematopoietic stem cell (allo-HSCT) setting. Pronounced gut dysbiosis often occurs in this population as a result of the massive use of ATBs for the prevention and treatment of transplant-related infectious complications.[34,42] Moreover, use of myeloablative conditioning regimens and parenteral feeding contributes to dysbiosis through mucosal tract injury. This may affect the entire microbiota, and lower bacterial diversity is indeed associated with an exacerbated all-cause mortality in the allo-HSCT population.[34] After analyzing the composition of the gut microbiota of 541 allo-HSCT patients, Peled et al. reported that patients harboring commensal Eubacterium limosum exhibited a decreased risk of relapse.[43] Supporting these findings, depletion of the normal microbiota in ATB-treated mice induced worse energy extraction, reduced visceral fat and impaired hematopoietic recovery, whereas the addition of caloric supplementation reversed these effects.[44] These findings coupled to the pre-clinical data described above provide compelling evidence that the gut microbiome determines the immune-cancer set point and that ATB administration may have important implications in the care of cancer patients receiving immune-modulatory treatments.