Ochi Nobuaki, Ichihara Eiki, Yokoyama Toshihide, Inoue Koji, Tamura Tomoki, Watanabe Hiromi, Takata Ichiro, Kano Hirohisa, Nakamura Kayo, Kawai Haruyuki, Inoue Masaaki, Fujimoto Nobukazu, Ichikawa Hirohisa, Ando Chihiro, Oze Isao, Takigawa Nagio, Maeda Yoshinobu, Hotta Katsuyuki
Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan.
Center for Clinical Oncology, Okayama University Hospital, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan.
Int J Clin Oncol. 2025 Aug 28. doi: 10.1007/s10147-025-02860-9.
Evidence suggests that antibiotic (ATB) use may negatively impact the efficacy of immune checkpoint inhibitors (ICIs) in treating advanced non-small cell lung cancer (NSCLC). We previously demonstrated that ATB use was significantly associated with decreased survival in NSCLC patients receiving ICI monotherapy. This study aimed to investigate the effect of ATB use on survival in NSCLC patients undergoing combined ICI and chemotherapy.
We evaluated the impact of ATB on survival in NSCLC patients treated with ICIs and chemotherapy in this multicenter retrospective study. We analyzed outcomes such as progression-free survival (PFS) and overall survival (OS) in patients who received ATB within 2 months before or 1 month after starting ICI and chemotherapy combination therapy.
Among 451 patients, 113 received ATB (ATB group) and 338 did not (ATB-unexposed). The median PFS was 7.1 months in the ATB group and 8.4 months in the ATB-unexposed group. The median OS was 18.0 months in the ATB group compared to 23.8 months in the ATB-unexposed group, indicating a significant reduction in both PFS and OS for the ATB group. Notably, this negative impact was not observed in patients who used probiotics (PFS: 6.0 vs. 7.6 months, p = 0.355; OS: 16.7 months vs. not reached (NR), p = 0.179).
ATB use was significantly associated with poorer survival outcomes in NSCLC patients treated with combined ICI and chemotherapy, but this effect was attenuated by probiotics.
有证据表明，抗生素（ATB）的使用可能会对免疫检查点抑制剂（ICI）治疗晚期非小细胞肺癌（NSCLC）的疗效产生负面影响。我们之前证明，在接受ICI单药治疗的NSCLC患者中，使用ATB与生存率降低显著相关。本研究旨在调查使用ATB对接受ICI联合化疗的NSCLC患者生存率的影响。
在这项多中心回顾性研究中，我们评估了ATB对接受ICI和化疗的NSCLC患者生存率的影响。我们分析了在开始ICI和化疗联合治疗前2个月内或后1个月内接受ATB的患者的无进展生存期（PFS）和总生存期（OS）等结局。
在451例患者中，113例接受了ATB（ATB组），338例未接受（未暴露于ATB组）。ATB组的中位PFS为7.1个月，未暴露于ATB组为8.4个月。ATB组的中位OS为18.0个月，而未暴露于ATB组为23.8个月，这表明ATB组的PFS和OS均显著降低。值得注意的是，在使用益生菌的患者中未观察到这种负面影响（PFS：6.0个月对7.6个月，p = 0.355；OS：16.7个月对未达到（NR），p = 0.179）。
在接受ICI联合化疗的NSCLC患者中，使用ATB与较差的生存结局显著相关，但益生菌可减轻这种影响。
