Current Problems in Cancer ( IF 2.6 ) Pub Date : 2021-06-05 , DOI: 10.1016/j.currproblcancer.2021.100760 Deniz Can Guven 1 , Ramazan Acar 2 , Emre Yekeduz 3 , Irem Bilgetekin 4 , Naziyet Kose Baytemur 5 , Cihan Erol 6 , Furkan Ceylan 1 , Mehmet Ali Sendur 6 , Umut Demirci 5 , Yuksel Urun 3 , Nuri Karadurmus 2 , Mustafa Erman 1 , Saadettin Kilickap 7
Background
Immunotherapy improves overall survival (OS) in the second and later lines of renal cell carcinoma (RCC) treatment. Recent studies have suggested that antibiotic (ATB) use either shortly before or after the start of immunotherapy could lead to decreased OS. Herein, we evaluate the impact of ATB use on OS in RCC patients treated with nivolumab in a multi-center cohort from Turkey.
Methods
The data of 93 metastatic RCC patients treated with nivolumab in the second line or later were retrospectively collected from 6 oncology centers. Previous treatments, sites of metastases, International Metastatic RCC Database Consortium risk classification, and ATB use in the three months before (-3) or three months after (+3) the start of immunotherapy were recorded together with survival data. The association of clinical factors with OS and progression-free survival (PFS) was analyzed with univariate and multivariable analyses.
Results
The median age was 61 (interquartile range 54-67), and 76.3% of the patients were male. The median OS of the cohort was 23.75 ± 4.41, and the PFS was 8.44 ± 1.61 months. Thirty-one (33.3%) patients used ATBs in the 3 months before (-3) or 3 months after (+3) nivolumab initiation. In the multivariable analyses, ATB exposure (HR: 2.306, 95% confidence interval [CI]: 1.155-4.601, P = 0.018) and the presence of brain metastases at the baseline (HR: 2.608, 95% CI: 1.200-5.666, P = 0.015) had a statistically significant association with OS, while ATB exposure was the only statistically significant parameter associated with PFS (HR: 2.238, 95% CI: 1.284-3.900, P = 0.004).
Conclusion
In our study, patients with ATB exposure in the 3 months before or 3 months after the start of immunotherapy had shorter OS. Our findings further support meticulous risk–benefit assessments of prescribing ATBs for patients who are either receiving or are expected to receive immunotherapy.
中文翻译:
接受免疫治疗的肾细胞癌患者抗生素使用与生存之间的关联:一项多中心研究
背景
免疫疗法可提高肾细胞癌 (RCC) 治疗的二线和后续线的总生存期 (OS)。最近的研究表明,在免疫治疗开始之前或之后不久使用抗生素 (ATB) 可能会导致 OS 降低。在此,我们在土耳其的一个多中心队列中评估了 ATB 使用对接受 nivolumab 治疗的 RCC 患者 OS 的影响。
方法
回顾性收集了来自 6 个肿瘤中心的 93 例二线及以后接受纳武单抗治疗的转移性 RCC 患者的数据。与生存数据一起记录之前的治疗、转移部位、国际转移性 RCC 数据库联盟风险分类和免疫治疗开始前三个月 (-3) 或后三个月 (+3) 的 ATB 使用情况。通过单变量和多变量分析分析临床因素与 OS 和无进展生存期 (PFS) 的关系。
结果
中位年龄为 61 岁(四分位距 54-67),76.3% 的患者为男性。该队列的中位 OS 为 23.75 ± 4.41,PFS 为 8.44 ± 1.61 个月。31 名 (33.3%) 患者在开始使用纳武利尤单抗前 3 个月 (-3) 或后 3 个月 (+3) 使用 ATB。在多变量分析中,ATB 暴露(HR:2.306,95% CI:1.155-4.601,P = 0.018)和基线时存在脑转移(HR:2.608,95% CI:1.200-5.666,P = 0.015)与 OS 具有统计学显着相关性,而 ATB 暴露是与 PFS 相关的唯一具有统计学意义的参数(HR:2.238,95% CI:1.284-3.900,P = 0.004)。
结论
在我们的研究中,在免疫治疗开始前 3 个月或之后 3 个月暴露于 ATB 的患者 OS 较短。我们的研究结果进一步支持对正在接受或预计将接受免疫治疗的患者开具 ATB 处方的细致风险收益评估。