Our microbiome, made up by the cooties that live within our bodies that, depending on which sort they are, either help protect us from disease or make us more susceptible to it, has been a hot topic in pop culture (HA!!!, I crack myself up!!), PR and advertising campaigns for a wide variety of products, as well as medicine. I've written a good deal about it over the past couple of years. Here are links to two of the most recent posts with lots of links within:
March 2018: More shoo shoo! Or...intestinal flora and melanoma
January 2018: Microbes again...and how they may be associated with improved response to anti-PD-1 for melanoma patients...and you might even laugh!!!
Now, if it is so that our microbiome makes a difference in our health, and I believe it does, then it makes sense that if we do something (through diet or medicine) that kills off bacteria that work to our advantage, we are clearly putting ourselves at risk. The problem is that not all bacteria do a body good! Antibiotics have saved untold lives ever since Fleming discovered the mold contaminating his petri plates!! Still, we have also learned that indiscriminate use of antibiotics in animals that become our food, as a treatment for viruses (which they DO NOT KILL!!!!!) and other inappropriate uses of these precious medications puts us at risk for the development of "super germs" for which we have no antibiotics to use against, as well as the destruction of "cooties" within us that PROTECT our health. In regard to immunotherapy and melanoma treatment specifically, I wrote this in 2017: Antibiotic use MAY decrease effectiveness of immunotherapy????? Where I wrote in part:
The article which discusses a study that looked at renal cancer patients on various immunotherapies (anti-CTLA-4, anti-PD-1, anti-PD-L1 and nivo specifically) and efficacy when patients had and had not been exposed to antibiotics is noted below, but here's the link: http://www.onclive.com/conference-coverage/gu-2017/antibiotic-use-may-damper-the-efficacy-of-checkpoint-inhibitors.
I can only imagine the author intended to write "Dampen" rather than "Damper"!!! (How is it that others are paid for writing this mess and I am not???? Hmmmm....) At any rate, data already theoretically supporting this premise is the idea that certain intestinal flora, bifidobacterium in particular, which would be killed off by certain antibiotics, promote the efficacy of immunotherapy...as was noted in this post: Cooties in our gut keep us skinny, smart and cure cancer!?????
On the other hand...there is this on doxycycline....an old antibiotic...though this is strictly relative to melanoma itself...NOT the use of immunotherapy (see the 2nd and 3rd articles in this post): EVERYTHING cures melanoma....so why do we have it??????
And, now...there's this:
Antibiotics are associated with decreased progression-free survival of advanced melanoma patients treated with immune checkpoint inhibitors. Elkrief, Raichani, Richard, et al. Oncoimmunology. 2019 Feb 18.
Background: The gut microbiota has been shown to be an important determinant of the efficacy of immune checkpoint inhibitions (ICI) in cancer. Several lines of evidence suggest that antibiotic (ATB) usage prior to or within the first month of ICI initiation negatively impacts clinical outcomes. Methods: We examined patients with advanced melanoma treated with an anti-PD-1 monoclonal antibody (mAb) or an anti-CTLA-4 mAb alone or in combination with chemotherapy. Those receiving ATB within 30 days of beginning ICI were compared with those who did not receive ATB. Response rates as determined by RECIST 1.1, progression-free survival (PFS), overall survival (OS) and immune-related toxicities were assessed. Results: Of these 74 patients analyzed, a total of 10 patients received ATB (13.5%) within 30 days of initiation of ICI. Patients who received ATB 30 days prior to the administration of ICI experienced more primary resistance (progressive disease) (0% of the objective response rate compared to 34%), and progression-free survival (PFS) was significantly shorter (2.4 vs 7.3 months). Overall survival (OS) was also shorter; however, this was not statistically significant (10.7 vs 18.3 months). The multivariate analysis further supported that ATB administration was associated with worse PFS. Conclusion: These findings suggest that ATB use within 30 days prior to ICI initiation in patients with advanced melanoma may adversely affect patient outcomes.
Small numbers. But the 10 folks, from the 74 advanced melanoma peeps examined, who were given antibiotics within 30 days of their immunotherapy, had more resistance to treatment, a shorter length of progression free survival (2.4 vs 7.3 months) and overall survival was shorter at 10.7 months vs 18.3 months.
So...if you really NEED antibiotics, they may save your life and will certainly decrease misery. BUT, if you DON'T really NEED them...they can cause harm, in lots of ways. For what it's worth. - c
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