Association of antibiotic exposure with survival in patients with extensive-stage small cell lung cancer receiving immune checkpoint inhibitor therapy.

BACKGROUND: Immune checkpoint inhibitors (ICIs) have dramatically shifted the therapeutic paradigm of extensive-stage small cell lung cancer (ES-SCLC). Antibiotic (ATB) exposure before or during ICI therapy can harm the integrity of the gut microbiome and lead to intestinal dysbiosis, which has a profoundly negative impact on the treatment response for various malignancies. Whether this is applicable to ES-SCLC remains unclear. METHODS: We retrospectively reviewed the electronic medical records of all patients diagnosed with ES-SCLC who were treated with ICI-based immunotherapies from July 2019 to December 2020 at Shandong Cancer Hospital and Institute, China. Outcomes with the use of ATBs before or after the first infusion of ICI, including progression-free survival (PFS) and overall survival (OS), were investigated using the Kaplan-Meier method. Multivariate analyses were also conducted using a Cox proportional hazards model. RESULTS: A total of 214 patients were included, among whom 41 (19.2%) received ATBs within 2 months before or after the first initiation of ICI therapy and were assigned to the ATB group. The ATB group showed a shorter median PFS (4.3 vs. 6.3 months; HR = 1.43, 95% CI: 0.97-2.11; p = 0.043) and a significantly shorter median OS (6.9 vs. 13 months; HR = 1.47, 95% CI: 0.98-2.20; p = 0.033) than the non-ATB group. In the multivariate analysis, ATB exposure was markedly associated with worse PFS (HR = 1.47, 95% CI: 1.03-2.09, p = 0.035) and OS (HR = 1.46, 95% CI: 1.01-2.11, p = 0.043). CONCLUSIONS: Our results demonstrate that ATB exposure was significantly associated with worse survival in ES-SCLC patients who received ICI therapy.

Tertiary lymphoid structures combined with biomarkers of inflammation are associated with the efficacy of neoadjuvant immunochemotherapy in resectable non-small cell lung cancer: A retrospective study.

BACKGROUND: Neoadjuvant immunochemotherapy can effectively downstage tumors and reduce the risk of postoperative recurrence and distant metastasis in patients with non-small cell lung cancer (NSCLC). In this study, we investigated the correlation between inflammatory biomarkers and tertiary lymphoid structure (TLS) expression. We also compared the predictive values of these inflammatory parameters, TLSs, and a combination of inflammatory parameters and TLSs for neoadjuvant efficacy in patients with NSCLC. METHODS: We retrospectively analyzed the clinical information of 106 patients with NSCLC who underwent neoadjuvant immunochemotherapy and radical surgery at Shandong Cancer Hospital between June 2020 and June 2022. RESULTS: TLS was evaluated using hematoxylin-eosin staining and immunohistochemically-stained tissue sections. Logistic analysis was performed to determine the correlation between inflammatory parameters, TLSs, and the factors affecting major pathological response (MPR). Receiver operating characteristic curves and the C-index were used to evaluate the predictive value of the nomogram models for MPR. The systemic immune-inflammatory index (SII) was an independent predictor of high TLS abundance and maturity. Platelet-to-lymphocyte ratio (PLR) ≤201.8, TLS abundance, and TLS maturity were independent predictors of MPR. The PLR-TLS combined model performed better in assessing the MPR in patients with NSCLC than models using single indicators. CONCLUSION: Our study demonstrated that the SII is an independent predictor of both TLS abundance and maturity. Both TLSs and PLR can predict MPR rates in patients with NSCLC receiving neoadjuvant immunochemotherapy. However, assessing the MPR in patients with NSCLC using a combination of PLR and TLSs is more accurate than using either indicator alone.