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Antibiotics Reduce Survival Rates In Cancer Patients Taking Immunotherapy

Cancer patients on immunotherapy fare worse if they have recently taken antibiotics, with their response and overall survival rate "crashing." 

The findings come from a study of almost 200 cancer patients in the UK taking a type of immunotherapy called checkpoint inhibitors, part of the standard treatment pathway for cancer patients on the NHS.

Researchers found that patients who received broad spectrum antibiotics in the month leading up to starting the treatment had significantly worse responses to immunotherapy.

Compared with patients who received antibiotics alongside the immunotherapy or not at all, antibiotic treatment before immunotherapy was associated with lower overall survival rates and patients' cancers were more likely to progress.

The researchers suggest this may be because antibiotics disrupt the balance of bacteria and microbes in the gut, called the microbiome, which in turn impact the immune system.

The prospective study, led by researchers at Imperial College London and published today in the journal JAMA Oncology, highlights the importance of the timing of antibiotic treatment and the need for further studies to understand the mechanisms at play.

The researchers say that the findings have the potential to influence clinical practice, including a higher threshold for giving antibiotics to cancer patients starting immunotherapy.

Dr. David Pinato, from Imperial's Department of Surgery & Cancer and corresponding author of the study, said: "Cancer immunotherapy can be successful in around 20 percent of patients, but it's very difficult to predict who is going to respond. This work adds further evidence that antibiotics have an impact. We have shown that with prior antibiotic exposure, patients' response to immunotherapy and survival crashes."

Immune response

In the study, the team looked at 196 patients receiving immunotherapy as part of their routine care on the NHS, and who were treated at Imperial College Healthcare and Chelsea and Westminster Hospital NHS Trusts.

Patients' primary disease included non-small cell lung cancer, melanoma, head and neck cancer, carcinomas and other types of cancer. All patients were treated with immune checkpoint inhibitors, a therapy which disrupts the ability of cancer cells to 'hide' themselves, enabling the body's immune cells to target and destroy tumours.

The researchers looked at whether patients had received broad spectrum antibiotics up to 30 days prior to beginning their immunotherapy treatment, or whether they received antibiotics during their therapy—with respiratory infections being the most common cause for being prescribed antibiotics.

A total of 26 patients received prior antibiotics and 68 received them during their immunotherapy, and median overall survival after therapy was 14.6 months.
However, analysis revealed that patients with prior antibiotic use had a median overall survival of just two months, compared to 26 months for those with no antibiotic use prior to treatment. A similar effect was seen across all cancer types.

Patients with prior antibiotic use were likely to be less responsive to immunotherapy, with their primary disease almost twice as likely to progress. The study also showed the effect was independent of the class of antibiotic used—which for this group of patients included beta-lactams, quinolones, macrolides, sulphonamides, tetracyclines, aminoglycosides and nitroimidazole.

Medical Express
To read this article in its entirety CLICK HERE.

Pamela Clark, CRNI, is an Infusion Nurse Coordinator at Healix, a leader in the field of parenteral services.  She has more than 28 years of experience in infusion therapy and infusion education with both licensed nurses and patients. Her experience spans multiple infusion settings including: acute care, long-term care, home infusion, and ambulatory infusion care. She also has experience in oncology and oncology research.  

Pam has been active in the Infusion Nurses Society, both locally and nationally. She currently sits on the Journal of Infusion Nursing editorial review board, is secretary of the Greater Houston INS Chapter, and has experience as a presenter at national INS conferences on various infusion-related topics. Ms. Clark holds a Bachelor’s Degree in Nursing from The University of Texas System School of Nursing at Austin. She has been certified in Infusion Nursing by the Infusion Nurses Credentialing Corporation for more than 25 years.  

Pam has written several courses on intravenous antibiotics.  Click on the course name to learn more.

Intravenous Antibiotics: Where We Are and Where We’re Going – Additional Classifications

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Intravenous Antibiotics: Where We Are and Where We’re Going – Antifungals

Intravenous Antibiotics: Where We Are and Where We’re Going – ß-lactams

Intravenous Antibiotics: Where We Are and Where We’re Going – Glycopeptides

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