Early Antibiotic Exposure Is Not Detrimental to Therapeutic Effect from Immunotherapy in Hepatocellular Carcinoma.

BACKGROUND AND RATIONALE

Immune checkpoint inhibitor (ICI) therapy is an expanding therapeutic option for hepatocellular carcinoma (HCC). Antibiotics (ATB) taken prior to or early during ICI therapy can impact immunotherapy efficacy across indications; however, the effect of ATB is undefined in HCC.

METHODS

In a large international cohort of 450 ICI recipients from Europe, North America, and Asia, we categorized patients according to timing of ATB focusing on exposure within -30 to +30 days from ICI (early immunotherapy period [EIOP]). EIOP was evaluated in association with overall survival (OS), progression-free survival (PFS), and best radiologic response using RECIST 1.1 criteria.

RESULTS

Our study comprised mostly cirrhotic (329, 73.3%) males (355, 79.1%) with a Child-Turcotte Pugh class of A (332, 73.9%), receiving ICI after 1 therapy line (251, 55.9%) for HCC of Barcelona clinic liver cancer stage C (325, 72.4%). EIOP (

CONCLUSIONS

Unlike other oncological indications, ATB in the 30 days before or after ICI initiation is associated with improved benefit from immunotherapy, independent of disease and treatment-related features. Evaluation of the immune microbiologic determinants of response to ICI in HCC warrants further investigation.

Informations de copyright

Copyright © 2021 by This is a work of the U.S. Government and is not subject to copyright protection in the United States. Foreign copyrights may apply. Published by S. Karger AG, Basel.

Déclaration de conflit d'intérêts

M.K. is the editor in chief of Liver Cancer. N.N. is an editorial board member of Liver Cancer. D.J.P. received lecture fees from ViiV Healthcare, Roche, EISAI, Bayer Healthcare, Falk Foundation; travel expenses from BMS, MSD, Roche, and Bayer Healthcare; consulting fees from Mina Therapeutics, EISAI, Roche, AstraZeneca, H3B, DaVolterra; received research funding (to institution) from MSD and BMS. DB has received lecture and speaker fees from Bayer Healthcare and the Falk Foundation Germany. Y.H.H. has received advisory board/consulting fees for BMS, MSD, Bayer Healthcare, IPSEN, EISAI, Gilead, and Lilly. A.S. received research funding (to institution) from AstraZeneca, Exelixis, BMS, and Clovis; advisory board/consulting fees from BMS, AstraZeneca, and Exelixis. A.C. received lecture fees from MSD, AstraZeneca, Astellas, and Novartis; consulting fees from MSD, Roche, AstraZeneca, Novartis, and BMS. There are no other personal or financial conflicts of interest to disclose. T.P. reports receiving institutional research funding from Lilly. N.P. reports receiving consulting fees from Amgen, Merck Serono, Servier; lectures fees from AbbVie, Gilead, Lilly; travel expenses from Amgen, ArQule; and institutional research funding from Basilea, Merck Serono, Servier. L.R. reports receiving consulting fees from Amgen, ArQule, AstraZeneca, Basilea, Bayer, Celgene, Eisai, Exelixis, Genenta, Hengrui, Incyte, Ipsen, Lilly, MSD, Nerviano Medical Sciences, Roche, Sanofi; lectures fees from AbbVie, Amgen, Eisai, Gilead, Incyte, Ipsen, Lilly, Roche, Sanofi; travel expenses from Ipsen; and institutional research funding from Agios, ARMO BioSciences, AstraZeneca, BeiGene, Eisai, Exelixis, Fibrogen, Incyte, Ipsen, Lilly, MSD, Nerviano Medical Sciences, Roche, and Zymeworks.