PD44-10 ASSOCIATION BETWEEN ANTIBIOTIC AND TREATMENT EFFICACY IN UROTHELIAL CARCINOMA PATIENTS RECEIVING IMMUNOTHERAPY OR CHEMOTHERAPY

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD44-10 ASSOCIATION BETWEEN ANTIBIOTIC AND TREATMENT EFFICACY IN UROTHELIAL CARCINOMA PATIENTS RECEIVING IMMUNOTHERAPY OR CHEMOTHERAPY Avery Braun, Laura Bukavina, Mengying Deng, M. Math, Elizabeth Handorf, and Philip Abbosh Avery BraunAvery Braun More articles by this author , Laura BukavinaLaura Bukavina More articles by this author , Mengying DengMengying Deng More articles by this author , M. MathM. Math More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , and Philip AbboshPhilip Abbosh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003354.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Research suggest ABT-induced dysbiosis impacts responses to immune checkpoint inhibitors (ICI) therapy. We investigated the association between ABT and overall survival (OS) and real-world progression free survival (rwPFS) in patients with metastatic urothelial carcinoma (mUC) receiving either ICI or non-ICI (cisplatin-based chemotherapy) as a reference group. METHODS: We included 5,622 patients with mUC from the nationwide Flatiron Health electronic health record -derived de-identified database (ICI N=1483; non-ICI N=4139). rwPFS and OS were calculated from treatment initiation to date of real-world progression/death. 3-month landmark Kaplan Meier methods and log-rank tests were used to estimate and compare rwPFS and OS between patients with ABT who received ICI and non-ICI. Cox proportional models were used to investigate the association between rwPFS, OS, and antibiotic use, and treatment modality, adjusting for patient characteristics. RESULTS: 407 (27.4%) ICI and 1523 (36.8%) non-ICI patients received ABT (p<0.001). ICI (OR 0.704, p<0.001) and older age (OR 0.979, p<0.001) were associated with lower ABT use in multivariable analysis. The association between ABT and rwPFS and OS were not significantly different between ICI (rwPFS p=0.43; OS p=0.07) and non-ICI groups (rwPFS p=0.60; OS p=0.99; Figure 1). Timing of ABT as associated with reduced OS in ICI-recipients who received post-treatment ABT (ICI median: pre- 17.0 vs post- 10.9 vs none- 16.0; p=0.005) while rwPFS was not statistically impacted by timing of antibiotic in either group (ICI p=0.22; non-ICI p=0.84; Figure 2) In multivariable analysis, ABT was associated with OS in the ICI cohort only (HR 1.228, p=0.022). CONCLUSIONS: This study identifies an ICI-specific potential negative effect of ABT on OS in patients with mUC. These results support continued investigation of the gut microbiome health on UC treatment efficacy and emphasize the importance of antibiotic stewardship. Source of Funding: DoD # (CA181178)Fox Core Grant # (P30 CA 006927) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1128 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avery Braun More articles by this author Laura Bukavina More articles by this author Mengying Deng More articles by this author M. Math More articles by this author Elizabeth Handorf More articles by this author Philip Abbosh More articles by this author Expand All Advertisement PDF downloadLoading ...