Antibiotic Exposure and Treatment Outcomes in Head and Neck Squamous Cell Carcinoma and Nasopharyngeal Carcinoma: A Systematic Review and Meta-Analysis.
Dimitra Psyllia, Dimitrios Stylianakis, Nerina Denaro et al.
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In 30 seconds
This systematic review and meta-analysis assessed whether systemic antibiotic exposure around treatment initiation was associated with outcomes in patients with head and neck squamous cell carcinoma or nasopharyngeal carcinoma receiving immune checkpoint inhibitors, definitive chemoradiotherapy, or chemo-immunotherapy. Eleven studies included 6,293 patients, with nine studies contributing to survival analyses. Antibiotic exposure was associated with worse overall survival (HR 1.78, 95% CI 1.52-2.08) and progression-free survival (HR 1.58, 95% CI 1.28-1.96). The evidence was predominantly observational, and the authors cautioned that confounding prevents causal conclusions.
Key findings
- Across survival analyses, antibiotic exposure was associated with worse overall survival (HR 1.78, 95% CI 1.52-2.08).
- Antibiotic exposure was associated with worse progression-free survival (HR 1.58, 95% CI 1.28-1.96).
- Associations with worse survival were reported in both ICI-treated and CRT cohorts.
- Objective response rate was descriptively lower among antibiotic-exposed patients.
Why it matters
The findings suggest that antibiotic exposure near cancer treatment initiation may identify patients with poorer outcomes across these treatment settings. This is clinically relevant when interpreting prognosis and designing studies of the microbiome and cancer therapy. However, antibiotics may be prescribed because of illness or other factors linked to survival, so the observed associations do not establish that antibiotics themselves worsen outcomes.
What to keep in mind
Most included studies had serious or high risk of bias, particularly from confounding by indication; the predominantly observational evidence precludes causal inference.