Bladder cancer: antibiotic use with atezolizumab is tied to worse survival

  • Hopkins AM & al.
  • Eur Urol
  • 11 Jul 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Antibiotic use is associated with worse survival outcomes in patients with locally advanced/metastatic urothelial carcinoma treated with atezolizumab.

Why this matters

  • Future research should explore the effect of antibiotics on other immune checkpoint inhibitors.
  • The findings suggest a need for extra caution with immune checkpoint inhibitors.

Study design

  • Post hoc analysis of single-group, phase 2 IMvigor210 (n=429) and randomized phase 3 IMvigor211 (n=467) trial including patients with advanced/metastatic urothelial carcinoma.
  • Funding: None disclosed.

Key results

  • In pooled cohort, antibiotic use within 30 days before and after immune checkpoint inhibitor was associated (all HRs; 95% CIs) with significantly worse:
    • OS: 1.44 (1.19-1.73).
    • PFS: 1.24 (1.05-1.46).
  • In patients treated with chemotherapy in IMvigor211, no significant association was observed between antibiotic use and:
    • OS: 1.15 (0.91-1.46).
    • PFS: 1.09 (0.88-1.36).
  • In IMvigor211 cohort, atezolizumab vs chemotherapy was associated with:
    • Similar OS in antibiotic users: 0.95 (0.71-1.25).
    • Improved OS in nonusers: 0.73 (0.60-0.88).

Limitations

  • Post hoc analysis.