Tumor histology Non squamous NSCLC br Lymph nodes
Tumor histology Non-squamous NSCLC5
Lymph nodes Lung Bone Other viscera CNS4 Smoking history
1 2 Number of metastatic sites (at IO)
Male Female Age, median (range) [years] Basal PS2 (at IO3)
Table 1 Patient characteristics.
anti-PD1 (nivolumab in 88 cases, pembrolizumab in 10 cases); 33.1% of patients received an anti-PD-L1 (durvalumab in 31 cases, atezolizumab in 16 cases, avelumab in 4 cases, MSB0011359C in 1 case); 1 patient received an anti-CTLA4 (tremelimumab); 6 patients received a com-bined IO (durvalumab + tremelimumab).
Eighty-two patients (52.2%) discontinued IO due to disease pro-gression, 30 (19.1%) for physician’s decision as a consequence of clinical deterioration, 10 (6.4%) after regular conclusion of the planned treatment program, one (0.6%) for patient’s withdrawal of consent. IO was still ongoing at the time of database lock in 34 cases (21.7%).
3.2. Antibiotic treatment characteristics
A total number of 46 patients (29.3%) received at least one ad-ministration of antibiotic through the WIOP.
Twenty-seven patients (17.2%) received 94885-02-6 during the
EIOP. In 7 cases (25.9%), more than one antibiotic was subsequently
administered. All patients received single agent antibiotic therapy.
Considering all the 46 patients receiving antibiotics, the prescrip-
tion was due to a respiratory tract infection in almost all cases. Four
100.0 patients (8.7%) received an antibiotic for a reactivation of diverticular
bowel disease, one for colitis, and one for urinary tract infection; all
59.9 these cases were also treated with a diﬀerent antibiotic for pneumonia.
40.1 According to the etiology, the most commonly prescribed antibiotic
was levofloxacin (30 cases, 65.2%), followed by amoxicillin/clavula-
84.7 The median duration of single cycle antibiotic was 6 days (range:
49.7 2–17 days). Considering the cumulative duration of the antibiotic
treatment, thus summing the length of single cycles, the median value
had an AIER higher than the median one. The median duration of an-
77.1 tibiotic treatment was significantly diﬀerent between the 2 subgroups
clinical and pathological variables were balanced between the 2 sub-
Median follow-up was 28.6 months.
Clinical and pathologic characteristics according to AIER.
Number of metastatic sites (at IO)
Line of IO
1 Antibiotic-Immunotherapy Exposure Ratio.
3 Performance Status.
5 Non small Cell Lung Cancer.
At univariate analyses, no impact on PFS was evidenced for smoking status, ICI mechanism of action, gender and age. A significant detri-mental eﬀect on PFS was observed for basal PS ≥ 1 and for second or more advanced IO lines. Similarly, no significant diﬀerences in median OS were seen when stratifying patients according to smoking status, ICI mechanism of action, gender, age, and IO line. The only variable ne-gatively impacting on OS was the basal PS (p < 0.0001) (Table 3).
Regarding the antibiotics eﬀects, the use of one or more anti-mi-crobic agents in the EIOP did not influence either PFS (3.3 months in non-treated patients versus 2.2 months in treated patients; p = 0.1772) or OS (11.9 months for non-treated patients versus 5.9 months for treated patients; p = 0.2492), although a numeric trend towards a better prognosis was seen for cases not receiving antibiotics (Table 3 and Fig. 1).
When considering a diﬀerent time cutoﬀ of 2 instead of 3 months after the first ICI administration, the results did not change (median PFS 3.35 in non-treated patients versus 2.2 in treated patients; p = 0.0992; median OS 11.9 months in non-treated patients versus 5.6 months in treated patients; p = 0.2147).
At multivariate analyses, the impact of AIER on PFS retained sig- nificance after correction for the eﬀects of basal PS (HR 1.053,
The immune system role in maintaining active surveillance against malignancies has been known for decades [34,35]. Pre-clinical and clinical data have demonstrated that immune-compromised hosts have a higher incidence of tumors that often show an aggressive behavior. Moreover, these subjects usually have a poorer response to treatments and a worse prognosis than immune-competent hosts .
The concept of immune activation against tumors has dramatically increased its relevance since ICIs introduction in the clinical practice. Indeed, the rationale for the use of these agents relies on the stimulation of systemic immunity against cancer, leading to an immune-mediated killing of malignant cells. In the last years there has been large increase of the therapeutic indications for IO, which is now part of the standard treatment in various malignancies .