The Use of Antibiotics During Immune Checkpoint Inhibitor Treatment Is Associated with Lower Survival in Advanced Esophagogastric Cancer.

Abstract

Immune checkpoint inhibitors (ICI) are effective in only a minority of patients with esophagogastric cancer (EGC). Here, we aimed to explore the impact of antibiotic use on outcomes in ICI-treated EGC patients. Patients with advanced EGC treated with ICIs at our center were identified between 2017 and 2021. The impact of antibiotic use on overall survival (OS) and progression-free survival (PFS) was assessed by a log-rank test. Eligible articles were retrieved using PubMed, the Cochrane Library, EMBASE, and Google Scholar by December 17, 2022. Clinical outcomes were OS, PFS, and disease control rate (DCR). In our cohort, 85 EGC patients were recruited. The results showed that antibiotic use significantly shortens OS (HR: 1.91, 95% CI: 1.11-3.28, P=0.020) and PFS (HR: 2.13, 95% CI: 1.21-3.74, P=0.009) and reduces DCR (OR: 0.27, 95% CI: 0.10-0.720, P=0.013) in EGC patients treated with ICIs. The meta-analysis results revealed that antibiotic use was significantly associated with worse OS (HR=2.454, 95% CI: 1.608-3.748, P<0.001), PFS (HR=2.539, 95% CI: 1.455-4.432, P=0.001), and lower DCR (OR=0.246, 95% CI: 0.105-0.577, P=0.001). No publication bias existed, and sensitivity analysis confirmed stable results. In patients with advanced EGC undergoing ICI, the use of antibiotics, such as cephalosporins, was associated with inferior survival rates.