Nie Fangfang, Guo JunGang, Pan JiaYi, Guo ZhaoJiao, Wang Chun, Yan Jun, Ma WeiNa
Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, 201800, China.
Department of Thoracic Surgery, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, 201800, China.
Clin Transl Oncol. 2025 Feb;27(2):790-799. doi: 10.1007/s12094-024-03615-0. Epub 2024 Jul 24.
Immunotherapy using immune checkpoint inhibitors (ICIs) has shown several benefits over traditional therapies. However, the eligible population remains small. Antibiotic (ATB) use might reduce immunotherapy efficacy by disrupting the gut microbiota. However, in China, ATB effect on ICI therapy efficacy remains unelucidated. We aimed to assess the effects of ATBs on the anti-tumor efficacy of ICIs to provide a reference for clinical use.
We included 134 patients with advanced tumors undergoing ICI therapy at Shanghai Jiading District Central Hospital from January 1, 2021, to October 1, 2023. They were divided into Non-ATB and ATB groups based on ATB use within 30 days before and after ICI administration. Moreover, we compared progression-free (PFS) and overall (OS) survival between the groups.
Median PFS and OS were lower in the ATB than in the Non-ATB group (PFS: 4.0 vs. 5.5 months; OS: 5.4 vs. 6.5 months). Univariate analysis revealed that ATB use significantly affected PFS (hazard ratio [HR] = 2.318, 95% confidence interval [CI] = 1.281-4.194, P = 0.005) and OS (HR = 2.115, 95% CI = 1.161-3.850, P = 0.014). Moreover, multivariate analysis revealed poor PFS (HR = 2.573, 95% CI = 1.373-4.826, P = 0.003) and OS (HR = 2.452, 95% CI = 1.298-4.632, P = 0.006) in patients who received ATBs during ICI therapy.
ATB use is negatively correlated with ICI therapy efficacy, leading to reduced PFS and OS in patients undergoing such treatment. Owing to the significant impact of ATBs on the human gut microbiome, regulation of the gut microbiome may emerge as a novel therapeutic target that can enhance the clinical activity of ICIs.
使用免疫检查点抑制剂（ICI）的免疫疗法已显示出比传统疗法更多的益处。然而，符合条件的人群仍然较少。抗生素（ATB）的使用可能会通过破坏肠道微生物群而降低免疫疗法的疗效。然而，在中国，ATB对ICI治疗疗效的影响仍不明确。我们旨在评估ATB对ICI抗肿瘤疗效的影响，为临床应用提供参考。
我们纳入了2021年1月1日至2023年10月1日在上海市嘉定区中心医院接受ICI治疗的134例晚期肿瘤患者。根据ICI给药前后30天内是否使用ATB，将他们分为非ATB组和ATB组。此外，我们比较了两组之间的无进展生存期（PFS）和总生存期（OS）。
ATB组的中位PFS和OS低于非ATB组（PFS：4.0个月对5.5个月；OS：5.4个月对6.5个月）。单因素分析显示，使用ATB显著影响PFS（风险比[HR]=2.318，95%置信区间[CI]=1.281-4.194，P=0.005）和OS（HR=2.115，95%CI=1.161-3.850，P=0.014）。此外，多因素分析显示，在ICI治疗期间接受ATB治疗的患者中，PFS（HR=2.573，95%CI=1.373-4.826，P=0.003）和OS（HR=2.452，95%CI=1.298-4.632，P=0.006）较差。
ATB的使用与ICI治疗疗效呈负相关，导致接受此类治疗的患者PFS和OS降低。由于ATB对人体肠道微生物群有显著影响，调节肠道微生物群可能成为一种新的治疗靶点，可增强ICI的临床活性。
