Highlights
- •Microbiota changes may have a role on anti-cancer treatment efficacy.
- •Antibiotics during the oncologic treatment associated with worse survival in LAHNC.
- •Antibiotic treatment correlated with increased risk of locoregional relapse.
Abstract
Background
Pre-clinical evidence suggests reduced efficacy of anticancer treatment in patients
exposed to broad-spectrum antibiotics. It is hypothesised that this phenomenon may
be explained by the effects of antibiotics on the composition of the microbiota. To
assess this in a clinical setting, we analysed the impact of antibiotics in patients
with locally advanced head and neck cancer (LAHNC) treated with curative intent with
chemotherapy and radiotherapy (RT).
Material and methods
Retrospective data for LAHNC patients treated with curative intent (245 induction
chemotherapy followed by chemoradiation [CRT], 17 surgery followed by post-operative
CRT, six CRT, three RT alone and one RT with concurrent cetuximab) were analysed.
We evaluated the impact of antibiotics prescribed during primary anti-cancer treatment
on progression-free survival (PFS), overall survival (OS) and disease-specific survival
(DSS) rates by multivariate Kaplan–Meier and Cox proportional hazards regression analysis.
Results
Among 272 patients, those receiving antibiotics between within 1 week before and 2
weeks after treatment (N = 124) progressed significantly earlier and had lower OS and DSS rates. In the multivariate
analysis, administration of antibiotics was independently associated with reduced
PFS (hazards ratio [HR] 1.98, P = 0.001), OS (HR 1.85, P = 0.001) and DSS (HR 1.95, P = 0.004). This effect was maintained with independence of reason for prescription,
type and time of antibiotic prescription. The negative impact was greater for patients
who received two or more courses of antibiotics. Antibiotic treatment was correlated
with increased risk of locoregional relapse.
Conclusions
Our data suggest a negative impact of antibiotic therapy on treatment outcomes following
CRT with curative intent in patients with LAHNC. This potential harm should be considered
when prescribing broad-spectrum and prophylactic antibiotics for such patients.
Keywords
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Article info
Publication history
Published online: April 02, 2020
Accepted:
February 15,
2020
Received:
February 12,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
