Antibiotic use influences outcomes in advanced pancreatic adenocarcinoma patients

Chirayu Mohindroo; Merve Hasanov; Jane E Rogers; Wenli Dong; Laura R Prakash; Seyda Baydogan; Jonathan D Mizrahi; Michael J Overman; Gauri R Varadhachary; Robert A Wolff; Milind M Javle; David R Fogelman; Michael T Lotze; Michael P Kim; Matthew H G Katz; Shubham Pant; Ching-Wei D Tzeng; Florencia McAllister

doi:10.1002/cam4.3870

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Antibiotic use influences outcomes in advanced pancreatic adenocarcinoma patients

Journal article

Open access

Peer reviewed

Antibiotic use influences outcomes in advanced pancreatic adenocarcinoma patients

Chirayu Mohindroo, Merve Hasanov, Jane E Rogers, Wenli Dong, Laura R Prakash, Seyda Baydogan, Jonathan D Mizrahi, Michael J Overman, Gauri R Varadhachary, Robert A Wolff, …

Cancer medicine (Malden, MA), Vol.10(15), pp.5041-5050

08/2021

DOI: 10.1002/cam4.3870

PMID: 34250759

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Abstract

Recent studies defined a potentially important role of the microbiome in modulating pancreatic ductal adenocarcinoma (PDAC) and responses to therapies. We hypothesized that antibiotic usage may predict outcomes in patients with PDAC. We retrospectively analyzed clinical data of patients with resectable or metastatic PDAC seen at MD Anderson Cancer from 2003 to 2017. Demographic, chemotherapy regimen and antibiotic use, duration, type, and reason for indication were recorded. A total of 580 patients with PDAC were studied, 342 resected and 238 metastatic patients, selected retrospectively from our database. Antibiotic use, for longer than 48 hrs, was detected in 209 resected patients (61%) and 195 metastatic ones (62%). On resectable patients, we did not find differences in overall survival (OS) or progression-free survival (PFS), based on antibiotic intake. However, in the metastatic cohort, antibiotic consumption was associated with a significantly longer OS (13.3 months vs. 9.0 months, HR 0.48, 95% CI 0.34-0.7, p = 0.0001) and PFS (4.4 months vs. 2 months, HR 0.48, 95% CI 0.34-0.68, p = <0.0001). In multivariate analysis, the impact of ATB remained significant for PFS (HR 0.59, p = 0.005) and borderline statistically significant for OS (HR 0.69, p = 0.06). When we analyzed by chemotherapy regimen, we found that patients who received gemcitabine-based chemotherapy as first-line therapy (n = 118) had significantly prolonged OS (HR 0.4, p 0.0013) and PFS (HR 0.55, p 0.02) if they received antibiotics, while those receiving 5FU-based chemotherapy (n = 98) had only prolonged PFS (HR 0.54, p = 0.03). Antibiotics-associated modulation of the microbiome is associated with better outcomes in patients with metastatic PDAC.

Adult

Aged

Aged, 80 and over

Anti-Bacterial Agents - therapeutic use

Antineoplastic Agents - therapeutic use

Bacterial Infections - drug therapy

Carcinoma, Pancreatic Ductal - microbiology

Carcinoma, Pancreatic Ductal - mortality

Carcinoma, Pancreatic Ductal - secondary

Carcinoma, Pancreatic Ductal - therapy

Deoxycytidine - analogs & derivatives

Deoxycytidine - therapeutic use

Epidemiologic Methods

Female

Fluorouracil - therapeutic use

Gastrointestinal Microbiome - drug effects

Humans

Male

Middle Aged

Multivariate Analysis

Pancreatic Neoplasms - microbiology

Pancreatic Neoplasms - mortality

Pancreatic Neoplasms - pathology

Pancreatic Neoplasms - therapy

Progression-Free Survival

Retrospective Studies

Time Factors

Treatment Outcome

Details

Title: Subtitle: Antibiotic use influences outcomes in advanced pancreatic adenocarcinoma patients
Creators: Chirayu Mohindroo - The University of Texas MD Anderson Cancer Center
Merve Hasanov - The University of Texas MD Anderson Cancer Center
Jane E Rogers - The University of Texas MD Anderson Cancer Center
Wenli Dong - The University of Texas MD Anderson Cancer Center
Laura R Prakash - The University of Texas MD Anderson Cancer Center
Seyda Baydogan - The University of Texas MD Anderson Cancer Center
Jonathan D Mizrahi - The University of Texas MD Anderson Cancer Center
Michael J Overman - The University of Texas MD Anderson Cancer Center
Gauri R Varadhachary - The University of Texas MD Anderson Cancer Center
Robert A Wolff - The University of Texas MD Anderson Cancer Center
Milind M Javle - The University of Texas MD Anderson Cancer Center
David R Fogelman - The University of Texas MD Anderson Cancer Center
Michael T Lotze - University of Pittsburgh Medical Center
Michael P Kim - The University of Texas MD Anderson Cancer Center
Matthew H G Katz - The University of Texas MD Anderson Cancer Center
Shubham Pant - The University of Texas MD Anderson Cancer Center
Ching-Wei D Tzeng - The University of Texas MD Anderson Cancer Center
Florencia McAllister - The University of Texas MD Anderson Cancer Center
Resource Type: Journal article
Publication Details: Cancer medicine (Malden, MA), Vol.10(15), pp.5041-5050
DOI: 10.1002/cam4.3870
PMID: 34250759
NLM abbreviation: Cancer Med
ISSN: 2045-7634
eISSN: 2045-7634
Grant note: V Foundation Cancer Prevention and Research Institute of Texas Sabin Family Foundation AGA Foundation T32 CA009666 / NCI NIH HHS
Language: English
Date published: 08/2021
Academic Unit: Internal Medicine
Record Identifier: 9985177933102771

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