Relationship between reduced response to pabolizumab in treatment of advanced non-small cell lung cancer and antibiotic preconditioning

doi:10.3877/cma.j.issn.1674-6902.2024.04.009

Abstract

Abstract:

Objective

To analyze the relationship between antibiotic (ATB) pretreatment and the therapeutic response and prognosis of pembrolizumab in patients with advanced non-small cell lung cancer (NSCLC).

Methods

A total of 92 patients with advanced NSCLC treated with pembrolizumab in our hospital from January 2019 to January 2023 were retrospectively analyzed. The clinical data of the patients were collected, and the patients were divided into ATB (-) group and ATB (+ ) group according to whether they had received any ATB treatment within 30 days before pembrolizumab treatment. Objective response rate (ORR), disease control rate(DCR), disease progression, progression-free survival (PFS) and overall survival (OS) were recorded.

Results

There was no significant difference in ORR between the control group 27cases(36.00%) and the observation group 8 cases(11.76%)(P>0.05). The DCR in control group 65 cases(84.00%)was significantly higher than that in observation group 8 cases(47.06%)(P<0.05). Disease progression occurred in 26 patients(34.67%) in the control group and 11 patients(64.71%) in the observation group (P<0.05).Case fatality rate in control group 7 cases(9.33%) lower than observation group 11 cases(64.71%)(P<0.05). Multivariate COX regression analysis found that ATB(+ ) was the only independent risk factor associated with disease progression and death. Kaplan-Meier mapping analyzed the relationship between ATB preconditioning and PFS in patients with advanced NSCLC. The median PFS in the observation group [1.77(0.33~14.00)months vs. 5.43(0.70~14.03)months, P=0.006], the median OS [7.17(1.90~14.00)months vs. 5.43(2.10~14.47)months, P=0.016] was significantly shorter than that of the control group.

Conclusions

In advanced NSCLC patients treated with pembrolizumab, ATB pretreatment within 30 days before treatment is associated with reduced therapeutic response and shorter survival.

Key words: Advanced non-small cell lung cancer, Antibiotics, Pembrolizumab, Therapeutic response

Song Liu, Jinzhao Zhang, Yanyun Jia. Relationship between reduced response to pabolizumab in treatment of advanced non-small cell lung cancer and antibiotic preconditioning[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(04): 553-557.

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References 27

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临床资料	对照组(n＝75)	观察组(n＝17)	Z/t/χ²	P值
临床分期[n(%)]			0.006	0.940
Ⅲ期	11(14.67)	2(11.76)
Ⅳ期	64(85.33)	15(88.24)
肿瘤最大直径[cm，M₅₀(P₂₅，P₇₅)]	2.55(1.55，4.95)	3.55(2.45，8.40)	－1.591	0.112
组织学类型[n(%)]			0.924	0.630
肺腺癌	38(50.67)	7(41.18)
肺鳞癌	26(34.67)	6(35.29)
其他	11(14.67)	4(23.53)
治疗[n(%)]
胸部放疗	20(26.67)	2(11.76)	1.691	0.193
根治性手术	15(20.00)	4(23.53)	0.105	0.746
实验室指标
Hb[g/L，(±s)]	129.00±18.60	128.47±23.88	0.100	0.920
CRP[mg/dl，M₅₀(P₂₅，P₇₅)]	0.28(0.10，0.40)	0.80(0.31，1.08)	－3.095	0.002
ALP[U/L，(±s)]	91.17±22.03	101.12±30.62	1.557	0.123
PLR[M₅₀(P₂₅，P₇₅)]	250.47(192.55，312.69)	182.16(147.93，318.02)	－0.840	0.401
LDH[U/L，M₅₀(P₂₅，P₇₅]	234.00(196.50，257.00)	265.50(208.50，321.50)	－1.922	0.055
ALB[g/L，(±s)]	40.76±4.68	39.65±4.98	0.873	0.385
LMR[M₅₀(P₂₅，P₇₅)]	1.32(0.99，1.54)	2.13(1.77，2.72)	－1.212	0.225
PD-L1表达(免疫组化)			0.950	0.330
免疫组化评分≥1	30(40.0)	9(52.94)
免疫组化评分<1	45(60.0)	8(47.06)

临床资料	对照组(n＝75)	观察组(n＝17)	Z/t/χ²	P值
临床分期[n(%)]			0.006	0.940
Ⅲ期	11(14.67)	2(11.76)
Ⅳ期	64(85.33)	15(88.24)
肿瘤最大直径[cm，M₅₀(P₂₅，P₇₅)]	2.55(1.55，4.95)	3.55(2.45，8.40)	－1.591	0.112
组织学类型[n(%)]			0.924	0.630
肺腺癌	38(50.67)	7(41.18)
肺鳞癌	26(34.67)	6(35.29)
其他	11(14.67)	4(23.53)
治疗[n(%)]
胸部放疗	20(26.67)	2(11.76)	1.691	0.193
根治性手术	15(20.00)	4(23.53)	0.105	0.746
实验室指标
Hb[g/L，(±s)]	129.00±18.60	128.47±23.88	0.100	0.920
CRP[mg/dl，M₅₀(P₂₅，P₇₅)]	0.28(0.10，0.40)	0.80(0.31，1.08)	－3.095	0.002
ALP[U/L，(±s)]	91.17±22.03	101.12±30.62	1.557	0.123
PLR[M₅₀(P₂₅，P₇₅)]	250.47(192.55，312.69)	182.16(147.93，318.02)	－0.840	0.401
LDH[U/L，M₅₀(P₂₅，P₇₅]	234.00(196.50，257.00)	265.50(208.50，321.50)	－1.922	0.055
ALB[g/L，(±s)]	40.76±4.68	39.65±4.98	0.873	0.385
LMR[M₅₀(P₂₅，P₇₅)]	1.32(0.99，1.54)	2.13(1.77，2.72)	－1.212	0.225
PD-L1表达(免疫组化)			0.950	0.330
免疫组化评分≥1	30(40.0)	9(52.94)
免疫组化评分<1	45(60.0)	8(47.06)

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