BACKGROUND Preclinical data have shown that proton pump inhibitors (PPI) can modulate the microbiome, and single-arm studies suggested that antibiotics (ATB) may decrease the efficacy of immune checkpoint inhibitors (ICI), but randomized controlled trial data are lacking. This pooled analysis evaluated the effect of ATB and PPI on outcome in patients randomized between ICI and chemotherapy. PATIENTS AND METHODS This retrospective analysis used pooled data from the phase II POPLAR (NCT01903993) and phase III OAK (NCT02008227) trials, which included 1512 patients with previously treated non-small-cell lung cancer (NSCLC) randomly assigned to receive atezolizumab (n = 757) or docetaxel (n = 755). The main objective of this analysis was to assess the impact of ATB and PPI use on overall survival (OS) and progression-free survival (PFS). RESULTS A total of 169 (22.3%) patients in the atezolizumab group and 202 (26.8%) in the docetaxel group received ATB, and 234 (30.9%) and 260 (34.4%), respectively, received PPI. Multivariate analysis in all patients revealed that ATB were associated with shorter OS [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.04-1.39], as was PPI (HR 1.26, 95% CI 1.10-1.44). Within the atezolizumab population, OS was significantly shorter in patients who received ATB (8.5 versus 14.1 months, HR 1.32, 95% CI 1.06-1.63, P = 0.01) or PPI (9.6 versus 14.5 months, HR 1.45, 95% CI 1.20-1.75, P = 0.0001). PPI use was associated with shorter PFS in the atezolizumab population (1.9 versus 2.8 months, HR 1.30, 95% CI 1.10-1.53, P = 0.001). There was no association between ATB and PPI use and PFS or OS within the docetaxel population. CONCLUSION In this unplanned analysis from two randomized trials, data suggest that ATB or PPI use in patients with metastatic NSCLC is associated with poor outcome and may influence the efficacy of ICI.

中文翻译：

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非小细胞肺癌接受抗生素和质子泵抑制剂治疗的化疗和atezolizumab的疗效：OAK和POPLAR试验的事后分析汇总。

背景技术临床前数据表明，质子泵抑制剂（PPI）可以调节微生物组，单臂研究表明，抗生素（ATB）可能会降低免疫检查点抑制剂（ICI）的功效，但缺乏随机对照试验数据。这项汇总分析评估了ATB和PPI对ICI和化疗之间随机分组的患者预后的影响。患者和方法这项回顾性分析使用了II期白杨（NCT01903993）和III期OAK（NCT02008227）试验的汇总数据，其中包括1512例先前接受过治疗的非小细胞肺癌（NSCLC）患者，这些患者被随机分配接受阿托珠单抗（n = 757）或多西他赛（n = 755）。该分析的主要目的是评估ATB和PPI使用对总体生存期（OS）和无进展生存期（PFS）的影响。结果Atezolizumab组共有169例（22.3％）患者，多西他赛组共有202例（26.8％）患者接受了ATB，PPI分别为234（30.9％）和260（34.4％）。所有患者的多变量分析显示，ATB与较短的OS相关[危险比（HR）1.20，95％置信区间（CI）1.04-1.39]，PPI也如此（HR 1.26，95％CI 1.10-1.44）。在atezolizumab人群中，接受ATB（8.5比14.1个月，HR 1.32，95％CI 1.06-1.63，P = 0.01）或PPI（9.6比14.5个月，HR 1.45，95％CI 1.20- 1.75，P = 0.0001）。使用PPI与atezolizumab人群中较短的PFS相关（1.9个月对2.8个月，HR 1.30，95％CI 1.10-1.53​​，P = 0.001）。在多西他赛人群中，ATB和PPI的使用与PFS或OS之间没有关联。