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

Disclosures

Ann Oncol. 2019;30(10):1572-1579. 

In This Article

Use of Other Concomitant Medications Influencing the Response to ICI

ATBs are not the only potentially immunomodulatory agents that may influence the clinical efficacy of ICI. For example, in a cohort including 640 NSCLC patients treated with ICI, the continuous use of more than 10 mg/day of corticosteroids was associated with decreased PFS and OS, as confirmed by both univariate and multivariate analysis.[59] Beyond its strong anti-inflammatory and immunosuppressive effects (that potentially interfere with the mode of action of ICI), corticotherapy may cause substantially shifts in the gut microbiota (e.g. dexamethasone causes an increase in the abundance of Clostridiales and Lactobacillaceae in mice).[60] Moreover, glucocorticoids are usually combined with as proton pump inhibitors, which also might impact on the gut microbiota.[61] However, the potential implication of the microbiota in long-term effects of glucocorticoids remain to be investigated. Of note, non-steroidal anti-inflammatory drugs have been shown to promote the infiltration of tumors by CD4+ and CD8+ T lymphocytes and to potentiate the effects of ICI in preclinical models.[62] Robust prospective trials analyzing the impact of co-medications on the gut microbiota and on ICI-induced anticancer immune responses should explore clinically relevant interactions.

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