Why it is worth to read "The negative impact of antibiotics on outcomes in cancer patients treated with immunotherapy…"
Rudi Schmidt
Precision Medicine, Real-World Data / Evidence, immune system, multiomics, AI, aging
Despite some people are still more or less skeptical on microbiome, the accumulation of evidence becomes stronger and stronger. Several recent studies validated the predictive impact of treatments with broad-spectrum antibiotics (ATB) on cancer patients receiving ICI. Neither these studies nor this latest review ("The negative impact of antibiotics on outcomes in cancer patients treated with immunotherapy…") can′t be simply ignored as the studies included more than 1800 patients in total, demonstrating the negative impact of ATB. This review comes with an overview of publications on the impact of the gut microbiome on ICI efficacy.
Immune checkpoint inhibitors (ICI) represent the standard of care for some cancer types. There has been remarkable progress to improve therapy regimes but long-lasting responses to ICI remain more the exception than the rule. E. g. in non-small cell lung cancer (NSCLC), primary resistance rates range from 35-44%, secondary resistance rates approach 100%(!)
To many it came as a surprise when the composition of gut microbiota (including bacteria, fungi, archaea and viruses) was associated with the therapeutic outcome of cancer patients to ICI.
Some conclusions of this latest review are striking:
- “Taken together, eleven out of twelve studies suggest a negative impact of ATBs on clinical outcome of patients with NSCLC, RCC or melanoma who are treated with ICIs targeting either PD-1 or PD-L1.”
- “… none of the studies took into account possible modulators of the gut microbiota such as diet, geography or other co-medications than ATBs that might constitute confounding factors.”
- “Treatment with broadspectrum ATBs during the month before the commencement of immunotherapy appears particular deleterious, more so than when ATBs have been administered before.”
Also remarkable are some of the questions that this paper raises:
- “Is it important to distinguish broad-spectrum combination ATB treatments from single-agent and short-course antibiotherapies, especially if they involve narrow-spectrum ATB?
- Are there ATBs that are particularly negative for clinical outcome?
- Or on the contrary, are there perhaps specific ATBs that might induce favorable alterations in the host immune system?
Link to the paper: https://academic.oup.com/annonc/advance-article-abstract/doi/10.1093/annonc/mdz206/5527755?redirectedFrom=fulltext