The prognostic impact of the administration of antibiotics and proton pump inhibitors (PPIs) in immune checkpoint inhibitor (ICI) therapy for advanced cancer has recently been documented. However, how these drugs affect the outcomes of first-line ICI combination therapy for advanced renal cell carcinoma (RCC) remains unclear.
We retrospectively evaluated the data of 128 patients with RCC who received first-line ICI combination therapy. The patients were grouped according to their history of antibiotics and PPIs use one month before the initiation of ICI combination therapy. Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) after ICI combination therapy were compared between patients treated with and without antibiotics or PPIs.
Of the 128 patients, 30 (23%) and 44 (34%) received antibiotics and PPIs, respectively. Patients treated with antibiotics exhibited shorter PFS and OS compared to those who did not receive antibiotics (median PFS: 4.9 vs. 16.1 months, p<0.0001; OS: 20.8 vs. 49.0 months, p=0.0034). Multivariate analyses showed that antibiotic administration was an independent predictor of shorter PFS (hazard ratio: 2.54: p=0.0002) and OS (hazard ratio: 2.56: p=0.0067) after adjusting for other covariates. In contrast, there were no significant differences in either PFS or OS between patients who received PPIs and those who did not. (PFS: p=0.828; OS: p=0.105).
Antibiotics administration before ICI combination therapy was negatively associated with outcomes of first-line ICI combination therapy for advanced RCC. Therefore, careful monitoring is required for potentially high-risk patients undergoing ICI combination therapy.
Cancer diagnosis & prognosis. 2024 Jul 03*** epublish ***
Nanaka Katsurayama, Hiroki Ishihara, Ryo Ishiyama, Yuki Nemoto, Takashi Ikeda, Shinsuke Mizoguchi, Takayuki Nakayama, Hironori Fukuda, Kazuhiko Yoshida, Junpei Iizuka, Hiroaki Shinmura, Yasunobu Hashimoto, Tsunenori Kondo, Toshio Takagi
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan., Department of Urology, Saiseikai Kazo Hospital, Kazo, Japan., Department of Urology, Jyoban Hospital, Fukushima, Japan., Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan., Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan.