Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide with a poor prognosis. Treatment with immune checkpoint inhibitors (ICIs) has improved overall survival in patients with HCC. However, not all patients benefit from the treatment. In this study, 59 patients with HCC were enrolled from two medical centers in Saudi Arabia, with 34% using antibiotics concurrently with their Nivolumab (anti-PD1 blockade). The impact of antibiotic use on the clinical outcomes of patients with HCC undergoing treatment with anti-PD1 blockade was examined. The patients’ overall survival (OS) was 5 months (95% CI: 3.2, 6.7) compared to 10 months (95% CI: 0, 22.2) (p= 0.08). Notably, patients with Child–Pugh A cirrhosis receiving anti-PD1 blockade treatment without concurrent antibiotic use showed a significantly longer median OS reaching 22 months (95% CI: 6.5, 37.4) compared to those who were given antibiotics with a median OS of 6 months (95% CI: 2.7, 9.2) (p= 0.02). This difference in overall survival was particularly found in Child–Pugh class A patients receiving anti-PD1 blockade. These findings suggest that antibiotic use may negatively affect survival outcomes in HCC patients undergoing anti-PD1 blockade, potentially due to antibiotic-induced alterations to the gut microbiome impacting the anti-PD1 blockade response. This study suggests the need for careful consideration when prescribing antibiotics to patients with HCC receiving anti-PD1 blockade.
肝细胞癌（HCC）是全球癌症死亡的第三大原因，预后较差。免疫检查点抑制剂（ICIs）治疗改善了HCC患者的总生存期。然而，并非所有患者都能从该治疗中获益。本研究从沙特阿拉伯的两家医疗中心纳入了59例HCC患者，其中34%的患者在使用纳武利尤单抗（抗PD-1阻断剂）的同时使用了抗生素。研究探讨了抗生素使用对接受抗PD-1阻断剂治疗的HCC患者临床结局的影响。使用抗生素的患者总生存期（OS）为5个月（95% CI：3.2, 6.7），而未使用抗生素的患者为10个月（95% CI：0, 22.2）（p=0.08）。值得注意的是，在Child-Pugh A级肝硬化患者中，未同时使用抗生素而接受抗PD-1阻断剂治疗的患者中位OS显著延长，达到22个月（95% CI：6.5, 37.4），而使用抗生素的患者中位OS仅为6个月（95% CI：2.7, 9.2）（p=0.02）。这种总生存期的差异在接受抗PD-1阻断剂治疗的Child-Pugh A级患者中尤为明显。这些发现表明，抗生素使用可能对接受抗PD-1阻断剂治疗的HCC患者的生存结局产生负面影响，这可能是由于抗生素引起的肠道微生物组改变影响了抗PD-1阻断剂的疗效。本研究提示，在为接受抗PD-1阻断剂治疗的HCC患者处方抗生素时需要慎重考虑。
肿瘤(癌症)患者之家