Deng Fang, Du Xiuwei, Zhang Ping, Xu Jing, Li Yu, Yang Zhongfei
Department of Oncology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, Shandong, China.
Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, Shandong, China.
Thorac Cancer. 2024 Dec;15(36):2560-2569. doi: 10.1111/1759-7714.15490. Epub 2024 Nov 17.
This study aimed to evaluate the impact of antibiotic exposure on efficacy and adverse reactions in non-small cell lung cancer (NSCLC) patients receiving chemoimmunotherapy, and to explore any specific associations on the basis of antibiotic class.
A retrospective study was conducted on NSCLC patients who received chemoimmunotherapy in two Shandong hospitals between January 2018 and October 2023. The association between antibiotic exposure and progression-free survival (PFS), overall survival (OS), objective response rate (ORR) and incidence of immune related adverse reactions (irAE) of patients were evaluated.
Of the 316 patients, 134 (42.41%) received antibiotics (ATB group), and 182 (57.59%) did not (N-ATB group). There was no significant difference in PFS (aHR = 1.009, 95% CI: 0.770-1.323; p = 0.946) or OS (aHR = 1.420, 95% CI: 0.986-2.047; p = 0.060) between ATB and N-ATB groups. The impact on efficacy was related to the type of antibiotic. β-Lactams (aHR = 1.737, 95% CI: 1.148-2.629; p = 0.009), in particular β-lactam/β-lactamase inhibitor combinations (BLBLIs) (aHR = 1.885, 95% CI: 1.207-2.944, p = 0.005) were associated with poorer OS. However, quinolones (aHR = 1.192, 95% CI: 0.861-1.650; p = 0.291) were not associated with OS. The incidence of irAEs was not significantly different between ATB and N-ATB groups (p = 0.073), but was higher with BLBLIs (p = 0.013).
In NSCLC patients receiving chemoimmunotherapy, no significant difference was observed in efficacy and incidence of irAEs between the ATB and the n-ATB groups. In antibiotic class analysis, β-lactams and specifically BLBLIs were observed to be associated with worse OS.
本研究旨在评估抗生素暴露对接受化疗免疫治疗的非小细胞肺癌（NSCLC）患者疗效和不良反应的影响，并基于抗生素类别探索任何特定关联。
对2018年1月至2023年10月期间在山东两家医院接受化疗免疫治疗的NSCLC患者进行回顾性研究。评估抗生素暴露与患者无进展生存期（PFS）、总生存期（OS）、客观缓解率（ORR）及免疫相关不良反应（irAE）发生率之间的关联。
316例患者中，134例（42.41%）接受了抗生素治疗（抗生素组），182例（57.59%）未接受（非抗生素组）。抗生素组与非抗生素组在PFS（调整后风险比[aHR]=1.009，95%置信区间[CI]：0.770 - 1.323；p = 0.946）或OS（aHR = 1.420，95% CI：0.986 - 2.047；p = 0.060）方面无显著差异。对疗效的影响与抗生素类型有关。β-内酰胺类（aHR = 1.737，95% CI：1.148 - 2.629；p = 0.009），特别是β-内酰胺/β-内酰胺酶抑制剂联合制剂（BLBLIs）（aHR = 1.885，95% CI：1.207 - 2.944，p = 0.005）与较差的OS相关。然而，喹诺酮类（aHR = 1.192，95% CI：0.861 - 1.650；p = 0.291）与OS无关。抗生素组与非抗生素组之间irAE的发生率无显著差异（p = 0.073），但BLBLIs组的发生率更高（p = 0.013）。
在接受化疗免疫治疗的NSCLC患者中，抗生素组与非抗生素组在疗效和irAE发生率方面未观察到显著差异。在抗生素类别分析中，观察到β-内酰胺类，特别是BLBLIs与较差的OS相关。
