Lung Cancer Unit-Ospedale Policlinico San Martino-Genova, Italy.
Cardiovascular and Respiratory Science, S. Andrea Hospital- Sapienza University Rome, Italy.
Crit Rev Oncol Hematol. 2019 Oct;142:26-34. doi: 10.1016/j.critrevonc.2019.07.005. Epub 2019 Jul 22.
The use of immune checkpoint inhibitors (ICIs) in cancer patients is rapidly growing. However, the potential impact of some widely used concomitant medications is still largely unclear. Emerging data suggest that gut microbiota may affect the efficacy of ICIs, leading to the hypothesis that concurrent antibiotics and proton pump inhibitors use could have a detrimental effect. In addition, steroid use might potentially impair the activity of immunotherapy, due its known immunosuppressive effects, and some safety concerns have been raised in patients receiving commonly used vaccination during ICIs. However, all randomized trials evaluating ICIs consistently excluded patients receiving high corticosteroid doses and data regarding other concomitant medications are lacking. Recently, several retrospective studies have tried to address this unmet medical need. Herein we discuss the latest evidence on the influence of these medications, critically analyzing the data reported so far and the possible implications in our clinical practice.
免疫检查点抑制剂（ICIs）在癌症患者中的应用正在迅速发展。然而，一些广泛使用的伴随药物的潜在影响在很大程度上仍不清楚。新出现的数据表明，肠道微生物群可能会影响 ICI 的疗效，从而提出假设，即同时使用抗生素和质子泵抑制剂可能会产生不利影响。此外，由于其已知的免疫抑制作用，类固醇的使用可能会削弱免疫疗法的活性，并且在接受 ICI 期间接受常用疫苗接种的患者中提出了一些安全问题。然而，所有评估 ICI 的随机试验都一致排除了接受高剂量皮质类固醇的患者，并且缺乏关于其他伴随药物的数据。最近，几项回顾性研究试图解决这一未满足的医疗需求。本文讨论了这些药物影响的最新证据，批判性地分析了迄今为止报告的数据以及对我们临床实践的可能影响。
