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Abstract：
OBJECTIVE: Medications regulating immune homeostasis and gut microbiota could affect the efficacy of immune checkpoint inhibitors (ICIs). This study aimed to investigate the impact of concurrent medications on the clinical outcomes of patients with cancer receiving ICI therapy in South Korea.
METHODS: We identified patients newly treated with ICI for non-small cell lung cancer (NSCLC), urothelial carcinoma (UC), and malignant melanoma (MM) between August 2017 and June 2020 from a nationwide database in Korea. The effect of concurrent antibiotics (ATBs), corticosteroids (CSs), proton-pump inhibitors (PPIs), and opioids prescribed within 30 days before ICI initiation on the treatment duration and survival was assessed.
RESULTS: In all, 8870 patients were included in the ICI cohort (NSCLC, 7,128; UC, 960; MM, 782). The patients were prescribed ATBs (33.8%), CSs (47.8%), PPIs (28.5%), and opioids (53.1%) at the baseline. The median overall survival durations were 11.1, 12.2, and 22.1 months in NSCLC, UC, and MM subgroups, respectively, since starting the ICI mostly as second-line (NSCLC and UC) and first-line (MM) therapy. Early progression was observed in 34.2% of the patients. Opioids and CS were strongly associated with poor survival across all cancer types. A high number of concurrent medications was associated with early progression and short survival. Opioid and CS use was associated with poor prognosis in all patients treated with ICIs. However, ATBs and PPIs had a cancer-specific effect on survival.
CONCLUSIONS: A high number of concurrent medications was associated with poor clinical outcomes.
METHODS: We identified patients newly treated with ICI for non-small cell lung cancer (NSCLC), urothelial carcinoma (UC), and malignant melanoma (MM) between August 2017 and June 2020 from a nationwide database in Korea. The effect of concurrent antibiotics (ATBs), corticosteroids (CSs), proton-pump inhibitors (PPIs), and opioids prescribed within 30 days before ICI initiation on the treatment duration and survival was assessed.
RESULTS: In all, 8870 patients were included in the ICI cohort (NSCLC, 7,128; UC, 960; MM, 782). The patients were prescribed ATBs (33.8%), CSs (47.8%), PPIs (28.5%), and opioids (53.1%) at the baseline. The median overall survival durations were 11.1, 12.2, and 22.1 months in NSCLC, UC, and MM subgroups, respectively, since starting the ICI mostly as second-line (NSCLC and UC) and first-line (MM) therapy. Early progression was observed in 34.2% of the patients. Opioids and CS were strongly associated with poor survival across all cancer types. A high number of concurrent medications was associated with early progression and short survival. Opioid and CS use was associated with poor prognosis in all patients treated with ICIs. However, ATBs and PPIs had a cancer-specific effect on survival.
CONCLUSIONS: A high number of concurrent medications was associated with poor clinical outcomes.
摘要：
目的：调节免疫稳态和肠道菌群的药物可能会影响免疫检查点抑制剂（ICIs）的疗效。这项研究旨在调查在韩国接受ICI治疗的癌症患者的临床结果的同时药物治疗的影响。
方法：我们确定了新接受ICI治疗的非小细胞肺癌（NSCLC）患者，尿路上皮癌(UC),2017年8月至2020年6月期间来自韩国全国数据库的恶性黑色素瘤（MM）。并发抗生素（ATB）的效果，皮质类固醇（CSs），质子泵抑制剂（PPI），和阿片类药物在ICI开始前30天内的治疗持续时间和生存率进行评估.
结果：总而言之，8870例患者被纳入ICI队列(NSCLC，7,128；UC，960;MM,782).患者服用ATB（33.8%），CSs（47.8%），PPI（28.5%），和阿片类药物（53.1％）在基线。NSCLC的中位总生存期为11.1、12.2和22.1个月，UC,和MM子组，分别,因为ICI主要作为二线（NSCLC和UC）和一线（MM）治疗开始。在34.2％的患者中观察到早期进展。阿片类药物和CS与所有癌症类型的低生存率密切相关。大量的并发药物与早期进展和短生存期相关。在所有接受ICIs治疗的患者中，阿片类药物和CS的使用与不良预后相关。然而,ATB和PPI对生存有癌症特异性影响。
结论：大量同时用药与不良临床结局相关。
方法：我们确定了新接受ICI治疗的非小细胞肺癌（NSCLC）患者，尿路上皮癌(UC),2017年8月至2020年6月期间来自韩国全国数据库的恶性黑色素瘤（MM）。并发抗生素（ATB）的效果，皮质类固醇（CSs），质子泵抑制剂（PPI），和阿片类药物在ICI开始前30天内的治疗持续时间和生存率进行评估.
结果：总而言之，8870例患者被纳入ICI队列(NSCLC，7,128；UC，960;MM,782).患者服用ATB（33.8%），CSs（47.8%），PPI（28.5%），和阿片类药物（53.1％）在基线。NSCLC的中位总生存期为11.1、12.2和22.1个月，UC,和MM子组，分别,因为ICI主要作为二线（NSCLC和UC）和一线（MM）治疗开始。在34.2％的患者中观察到早期进展。阿片类药物和CS与所有癌症类型的低生存率密切相关。大量的并发药物与早期进展和短生存期相关。在所有接受ICIs治疗的患者中，阿片类药物和CS的使用与不良预后相关。然而,ATB和PPI对生存有癌症特异性影响。
结论：大量同时用药与不良临床结局相关。
