Division of Gynecologic Oncology, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States of America.
Division of Gynecologic Oncology, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States of America.
Gynecol Oncol. 2021 Apr;161(1):211-220. doi: 10.1016/j.ygyno.2021.01.015. Epub 2021 Jan 24.
OBJECTIVE(S): To identify whether antibiotics (ABX) impact immunotherapy (ICI) response rate (RR), progression-free survival (PFS), and overall survival (OS) in women with recurrent endometrial (EC), cervical (CC) and ovarian cancer (OC).
This retrospective cohort study included women with recurrent EC, CC, and OC treated with ICIs from 1/1/17-9/1/2020. ABX were defined as 30 days before (pABX) or concurrently (cABX) with ICI. The impact of ABX upon PFS and OS was assessed by univariate analysis and multivariable Cox regression.
Of 101 women, 52.5% (n = 53) had recurrent EC, 21.4% (n = 22) CC and 25.7% (n = 26) OC. 56.9% (n = 58) received ABX, with 22.8% (n = 23) pABX and 46.5% (n = 47) cABX. While no difference was observed in ICI RR for any ABX vs. none (p = 0.89) and cABX vs. none (p = 0.33), pABX (n = 23) were associated with decreased RR vs. none (n = 78) (Partial Response - 8.7% vs. 30.8%; Complete Response - 4.3% vs. 9.0%; p = 0.002). On univariate analysis, pABX were associated with worsened PFS (2.9 vs. 8.9 months; HR 2.53, 95% CI 1.48-4.31, p < 0.001) and OS (9.3 vs. 19.9 months; HR 2.29, 95% CI 1.22-4.32, p = 0.01). No PFS or OS difference was noted for cABX (PFS - 9.3 vs. 6.0 months; HR 0.70, 95% CI 0.43-1.12; p = 0.14; OS - 13.4 vs. 16.3 months; HR 0.89, 95% CI 0.51-1.54; p = 0.68). On multivariable analysis, pABX were associated with significantly decreased PFS (HR 3.10, 95% CI 1.75-5.49, p < 0.001) and OS (HR 3.03, 95% CI 1.50-6.10, p = 0.002).
In women with recurrent EC, OC, and CC receiving ICI, pABX, but not cABX, are associated with decreased RR, PFS, and OS. Further investigation is warranted to understand predictors of ICI response in women with gynecologic cancer.
确定抗生素 (ABX) 是否会影响接受免疫疗法 (ICI) 治疗的复发性子宫内膜 (EC)、宫颈 (CC) 和卵巢癌 (OC) 女性的反应率 (RR)、无进展生存期 (PFS) 和总生存期 (OS)。
本回顾性队列研究纳入了 2017 年 1 月 1 日至 2020 年 9 月 1 日期间接受 ICI 治疗的复发性 EC、CC 和 OC 女性。ABX 定义为 ICI 前 30 天 (pABX) 或同时 (cABX) 使用的抗生素。通过单因素分析和多变量 Cox 回归评估 ABX 对 PFS 和 OS 的影响。
在 101 名女性中，52.5% (n=53) 患有复发性 EC，21.4% (n=22) 患有 CC，25.7% (n=26) 患有 OC。56.9% (n=58) 接受了 ABX，其中 22.8% (n=23) 使用 pABX，46.5% (n=47) 使用 cABX。虽然任何 ABX 与无 ABX 相比，ICI RR 没有差异 (p=0.89)，cABX 与无 ABX 相比，ICI RR 也没有差异 (p=0.33)，但与无 ABX (n=78) 相比，pABX (n=23) 的 RR 降低 (部分缓解-8.7% vs. 30.8%；完全缓解-4.3% vs. 9.0%；p=0.002)。单因素分析显示，pABX 与 PFS 恶化相关 (2.9 与 8.9 个月；HR 2.53，95%CI 1.48-4.31，p<0.001) 和 OS 缩短相关 (9.3 与 19.9 个月；HR 2.29，95%CI 1.22-4.32，p=0.01)。cABX 对 PFS 或 OS 无影响 (PFS-9.3 与 6.0 个月；HR 0.70，95%CI 0.43-1.12；p=0.14；OS-13.4 与 16.3 个月；HR 0.89，95%CI 0.51-1.54；p=0.68)。多因素分析显示，pABX 与 PFS 显著缩短相关 (HR 3.10，95%CI 1.75-5.49，p<0.001) 和 OS 缩短相关 (HR 3.03，95%CI 1.50-6.10，p=0.002)。
在接受 ICI 治疗的复发性 EC、OC 和 CC 女性中，pABX 而非 cABX 与 RR、PFS 和 OS 降低相关。需要进一步研究以了解妇科癌症患者 ICI 反应的预测因素。
