ABSTRACT & COMMENTARY
Antibiotics Show Benefit in Pancreatic Cancer Examining the link between antibiotics and survival REFERENCE
Weniger M, Hank T, Qadan M, et al. Influence of Klebsiella pneumoniae and quinolone treatment on prognosis in patients with pancreatic cancer. Br J Surg. 2021;108(6):709-716.
Jacob Schor, ND, FABNO
OUTCOME MEASURES
A retrospective study of patients from the Massachusetts General Hospital (USA) and Ludwig-Maximilians-University (Germany)
The primary outcomes examined were overall survival (OS) and progression-free survival (PFS). These measures were examined in light of the patients’ demographic data and preoperative treatments, plus additional adjuvant treatments. Bile microbiota were assessed using intraoperative cultures, and corresponding resistance patterns were analyzed. These outcomes were compared between those who had received quinolone antibiotics and those who had not.
PARTICIPANTS
KEY FINDINGS
DESIGN
Data were obtained for 211 patients who underwent preoperative treatment for borderline resectable pancreatic cancer (BRPC) or locally advanced (LAPC) pancreatic cancer followed by pancreatoduodenectomy with curative intent between January 2007 and December 2017, and for whom intraoperative bile cultures were available. Median age of patients was 65.9 years with a median follow up time of 18 months; 108 of these patients were women (51.2%) and mean BMI was 24.8. STUDY MEDICATION AND DOSAGE
Patients were treated with a range of different protocols during the decade these data were collected, including FOLFIRINOX alone and with radiation, proton-beam therapy and capecitabine, and gemcitabine in combination with various other chemotherapy drugs. Patient records were screened for postoperative treatment with quinolone antibiotics, either intravenous or oral. Patients who received any dose for any duration at any time between surgery and death were considered to have had quinolone treatment. About half of the patients (n=104) had been treated with quinolones. Associations between tumor characteristics, survival data, antibiotic use, and results of intraoperative bile cultures were investigated. Survival was analyzed using Kaplan-Meier curves and Cox regression analysis.
An increasing number of pathogen species found in intraoperative bile cultures was associated with a decrease in PFS (-1.9 months per species found; P=0.009). Overall, 48 different pathogens were cultured and identified from the bile samples obtained during surgery. Of these, only Klebsiella pneumoniae, which was cultured in 73 patients, was associated with reduced PFS (16.5 vs 20.7 months in patients who tested positive and negative for K. pneumoniae respectively; P=0.032). Patients with K. pneumoniae had larger tumors than patients without (mean 29.9 mm vs 23.7 mm; P=0.003). Adjuvant treatment with gemcitabine improved PFS in patients who were negative for K. pneumoniae (26.2 vs 15.3 months; P=0.039), but not in those who tested positive (19.5 vs 13.2 months; P=0.137). Quinolone treatment was associated with improved median overall survival (OS) independent of K. pneumoniae status (48.8 vs 26.2 months; P=0.006) and among those who tested positive for K. pneumoniae (median not reached versus 18.8 months; P=0.028). Patients with quinolone-resistant K. pneumoniae had shorter PFS than those with quinolone-sensitive K. pneumoniae (9.1 vs 18.8 months; P=0.001). K. pneumoniae appears to promote chemoresistance to adjuvant gemcitabine, and quinolone treatment is associated with improved survival.
6 ©2021 NATURAL MEDICINE JOURNAL. ALL RIGHTS RESERVED. NMJ, OCTOBER 2021 SUPPLEMENT—VOL. 13, NO. 101 (SUPPL)
