TY  - JOUR
AU  - Gambichler, Thilo
AU  - Weyer-Fahlbusch, Sera S
AU  - Overbeck, Jan
AU  - Abu Rached, Nessr
AU  - Becker, Jürgen
AU  - Susok, Laura
TI  - Impaired Overall Survival of Melanoma Patients Due to Antibiotic Use Prior to Immune Checkpoint Inhibitor Therapy: Systematic Review and Meta-Analysis.
JO  - Cancers
VL  - 17
IS  - 11
SN  - 2072-6694
CY  - Basel
PB  - MDPI
M1  - DKFZ-2025-01216
SP  - 1872
PY  - 2025
AB  - Background: The gut microbiome plays a pivotal role in shaping systemic immunity and modulating anti-tumor responses. Preclinical and clinical studies have shown that higher gut microbial diversity and the presence of specific commensal taxa correlate with improved responses to immune checkpoint inhibitors (ICI) in melanoma. Conversely, broad-spectrum antibiotics can induce dysbiosis, reducing T cell activation and cytokine production, and have been linked to diminished ICI efficacy in several cancer types. Methods: We conducted a systematic review and meta-analysis of seven retrospective cohorts (total n = 5213) comparing overall survival in cutaneous melanoma (CM) patients who did or did not receive systemic antibiotics within six weeks before ICI initiation. From each study, we extracted hazard ratios (HRs) for death, antibiotic-to-ICI interval, ICI regimen (PD-1 monotherapy vs. PD-1 + CTLA-4 combination), cohort size, and country. Pooled log-HRs were estimated under fixed-effect and random-effects (REML) models. Statistical heterogeneity was quantified by Cochran's Q and I2 statistics, and τ2. We performed leave-one-out sensitivity analyses, generated a Baujat plot to identify influential studies, applied trim-and-fill to assess publication bias, and ran meta-regressions for regimen, antibiotic timing, sample size, and geography. Results: Under the fixed-effect model, antibiotic exposure corresponded to a pooled HR of 1.26 (95
KW  - antibiosis (Other)
KW  - immunotherapy (Other)
KW  - infection (Other)
KW  - ipilimumab (Other)
KW  - mortality (Other)
KW  - nivolumab (Other)
KW  - pembrolizumab (Other)
LB  - PUB:(DE-HGF)16
C6  - pmid:40507352
DO  - DOI:10.3390/cancers17111872
UR  - https://inrepo02.dkfz.de/record/302018
ER  -