New Paper Alert! How concurrent Medication Impacts The Outcomes Of Patients Treated with Immune Checkpoint Inhibitors
How concurrent Medication Impacts The Outcomes Of Patients Treated with Immune Checkpoint Inhibitors
Published in the Journal of Cancer Research and Clinical Oncology, on April 10, 2024
Authors: Soojung Hong, Ju Hyun Lee, Ja Yoon Heo, Koung Jin Suh, Se Hyun Kim, Yu Jung Kim, Jee Hyun Kim
Introduction
ICIs have revolutionized cancer treatment by targeting the immune system’s brakes and restoring antitumor activity. However, not all patients respond favorably to ICI therapy, and identifying factors that influence treatment outcomes is crucial. The gut microbiome has emerged as a potential contributor to the variability in ICI response, and medications that affect immune homeostasis and the gut microbiome, such as ATBs, CSs, PPIs, and opioids, may impact the efficacy of ICIs.
Design
This population-based cohort study analyzed the impact of concurrent medications, including antibiotics (ATBs), corticosteroids (CSs), proton-pump inhibitors (PPIs), and opioids, on the clinical outcomes of patients with non-small cell lung cancer (NSCLC), urothelial carcinoma (UC), and malignant melanoma (MM) treated with immune checkpoint inhibitors (ICIs) in South Korea, using The National Health Insurance Service database. The study included 8,870 patients, with NSCLC (80.4%), UC (10.8%), and MM (8.8%). At baseline, patients were prescribed ATBs (33.8%), CSs (47.8%), PPIs (28.5%), and opioids (53.0%).
Key Highlights:
- The median overall survival was 11.1 months for NSCLC, 12.2 months for UC, and 22.1 months for MM patients.
- Early progressive disease (EPD) was observed in 34.2% of patients, and the risk of EPD increased with the number of concurrent medications used.
- NSCLC patients using antibiotics and proton-pump inhibitors saw decreased survival times, dropping to 6.3 and 8.1 months, respectively, from higher averages.
- For urothelial carcinoma, antibiotic use correlated with a reduced survival time to 8.1 months from 12.6 months.
- Using four medications (antibiotics, corticosteroids, proton-pump inhibitors, and opioids) increased the risk of early progressive disease by 4.36 times and poor overall survival by 3.17 times.
- High usage of opioids and corticosteroids was strongly associated with decreased survival across all cancer types.
- Antibiotics and proton-pump inhibitors showed cancer-specific effects, complicating the therapy outcomes.
Key Takeaway Messages:
- Concurrent use of certain medications, particularly opioids and corticosteroids, negatively impacts the efficacy of ICIs across different types of cancer.
- The type of concurrent medication and the number of medications used can significantly affect patient outcomes, underlining the need for careful prescription practices to optimize ICI therapy effectiveness.
- This study reinforces the importance of considering the full medication profile of cancer patients when planning and administering ICI therapy to improve clinical outcomes.
Summary by Amalya Sargsyan, MD