The negative impact of antibiotics on outcomes in cancer patients treated with immunotherapy: a new independent prognostic factor?

Immune-checkpoint inhibitors (ICI) now represent the standard of care for several cancer types. In pre-clinical models, absence of an intact gut microbiome negatively impacted ICI efficacy and these findings permitted to unravel the importance of the commensal microbiota in immuno-oncology. Recently...

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Bibliographic Details
Published inAnnals of oncology Vol. 30; no. 10; pp. 1572 - 1579
Main Authors Elkrief, A., Derosa, L., Kroemer, G., Zitvogel, L., Routy, B.
Format Journal Article
LanguageEnglish
Published England Elsevier Ltd 01.10.2019
Subjects
Anti-Bacterial Agents - adverse effects
antibiotics
Antineoplastic Agents, Immunological - adverse effects
cancer
Dysbiosis - drug therapy
Dysbiosis - microbiology
Dysbiosis - mortality
Gastrointestinal Microbiome - drug effects
Gastrointestinal Microbiome - immunology
Humans
immunotherapy
Immunotherapy - adverse effects
Immunotherapy - mortality
microbiome
Neoplasms - drug therapy
Neoplasms - mortality
Neoplasms - pathology
Prognosis
Survival Rate
cancer
antibiotics
microbiome
immunotherapy
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Summary:Immune-checkpoint inhibitors (ICI) now represent the standard of care for several cancer types. In pre-clinical models, absence of an intact gut microbiome negatively impacted ICI efficacy and these findings permitted to unravel the importance of the commensal microbiota in immuno-oncology. Recently, multiple clinical studies including more than 1800 patients in aggregate demonstrated the negative predictive impact of treatments with broad-spectrum antibiotics (ATB) on cancer patients receiving ICI. Altogether, these results have led to the hypothesis that ATB-induced dysbiosis might influence the clinical response through the modulation of the gut microbiome. Controversy still remains, as ATB treatment might simply constitute a surrogate marker of unfit or immunodeficient patients. In this review, we summarize recent publications addressing the impact of the gut microbiome on ICI efficacy, discuss currently available data on the effect of ATB administered in different time-frames respect to ICI initiation, and finally, evoke the therapeutic implications of these findings.
ISSN:0923-7534
1569-8041
DOI:10.1093/annonc/mdz206