Alshammari Kanan, Alotaibi Faizah M, Alsugheir Futoon, Aldawoud Mohammad, Alolayan Ashwaq, Algarni Mohammed Ahmad, Sabatin Fouad, Mohammad Mohammad F, Alosaimi Abdulaziz, Sanai Faisal M, Odah Hassan, Alshehri Ahmed Saleh, Aldibasi Omar S, Alrehaily Samah, Al Saleh Abdullah S
King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia.
Cancers (Basel). 2023 Dec 27;16(1):133. doi: 10.3390/cancers16010133.
Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide with a poor prognosis. Treatment with immune checkpoint inhibitors (ICIs) has improved overall survival in patients with HCC. However, not all patients benefit from the treatment. In this study, 59 patients with HCC were enrolled from two medical centers in Saudi Arabia, with 34% using antibiotics concurrently with their Nivolumab (anti-PD1 blockade). The impact of antibiotic use on the clinical outcomes of patients with HCC undergoing treatment with anti-PD1 blockade was examined. The patients' overall survival (OS) was 5 months (95% CI: 3.2, 6.7) compared to 10 months (95% CI: 0, 22.2) ( = 0.08). Notably, patients with Child-Pugh A cirrhosis receiving anti-PD1 blockade treatment without concurrent antibiotic use showed a significantly longer median OS reaching 22 months (95% CI: 6.5, 37.4) compared to those who were given antibiotics with a median OS of 6 months (95% CI: 2.7, 9.2) ( = 0.02). This difference in overall survival was particularly found in Child-Pugh class A patients receiving anti-PD1 blockade. These findings suggest that antibiotic use may negatively affect survival outcomes in HCC patients undergoing anti-PD1 blockade, potentially due to antibiotic-induced alterations to the gut microbiome impacting the anti-PD1 blockade response. This study suggests the need for careful consideration when prescribing antibiotics to patients with HCC receiving anti-PD1 blockade.
肝细胞癌（HCC）是全球癌症死亡的第三大主要原因，预后较差。使用免疫检查点抑制剂（ICI）进行治疗已改善了HCC患者的总生存期。然而，并非所有患者都能从该治疗中获益。在本研究中，从沙特阿拉伯的两个医疗中心招募了59例HCC患者，其中34%在使用纳武单抗（抗PD1阻断剂）的同时使用了抗生素。研究了抗生素使用对接受抗PD1阻断治疗的HCC患者临床结局的影响。患者的总生存期（OS）为5个月（95%置信区间：3.2，6.7），而未使用抗生素的患者为10个月（95%置信区间：0，22.2）（P = 0.08）。值得注意的是，与同时使用抗生素且中位OS为6个月（95%置信区间：2.7，9.2）（P = 0.02）的患者相比，未同时使用抗生素而接受抗PD1阻断治疗的Child-Pugh A级肝硬化患者的中位OS显著更长，达到22个月（95%置信区间：6.5，37.4）。这种总生存期的差异在接受抗PD1阻断治疗的Child-Pugh A级患者中尤为明显。这些发现表明，抗生素使用可能会对接受抗PD1阻断治疗的HCC患者的生存结局产生负面影响，这可能是由于抗生素引起的肠道微生物群改变影响了抗PD1阻断反应。本研究表明，在为接受抗PD1阻断治疗的HCC患者开抗生素处方时需要谨慎考虑。
