Observational studyJAMA network open2025
Concomitant Comedications and Survival With First-Line Pembrolizumab in Advanced Non-Small-Cell Lung Cancer.
Observational study in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The use of antibiotic, probiotic, and fecal microbiota transplantation in modulating immunotherapy efficacy and survival: a systematic review and meta-analysis of clinical outcomes.The oncologist · 2026Pooled it
- Antibiotics and probiotics differentially shape immunotherapy outcomes in non-small cell lung cancer.Cancer biology & medicine · 2026Article
- Host Determinants of Immune Checkpoint Inhibitor Efficacy: Immune, Genetic, Metabolic, and Lifestyle Factors.International journal of molecular sciences · 2026Review
- Review
- Gut dysbiosis in oncology: a risk factor for immunoresistance.Cell research · 2026Review
- Endocrine immune-related adverse events in advanced lung cancer patients receiving immune checkpoint inhibitors: incidence, predictors and outcomes.Translational lung cancer research · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: Antibiotics, steroids, and proton pump inhibitors (PPIs) are suspected to decrease the efficacy of immunotherapy. Objective: To explore the association of comedications with overall survival (OS) in patients with advanced non-small-cell lung cancer (NSCLC). Design, Setting, and Participants: This nationwide retrospective cohort study used target trial emulations of patients newly diagnosed with NSCLC from January 2015 to December 2022, identified from the French national health care database. Eligible patients were treated with pembrolizumab in a first-line setting and alive 2 months after initiating pembrolizumab. Exclusion criteria included hospitalization for infectious disease, autoimmune disorders, or peptic ulcer disease. Exposures: Antibiotic and PPI exposures were defined as at least 2 prescriptions 60 days before to 42 days after pembrolizumab start. Steroid exposure was defined as at least 2 prescriptions 30 days before to 30 days after pembrolizumab start. Main Outcomes and Measures: The primary outcome was OS. Patients exposed were compared with those without exposure, using inverse probability of treatment weighting (IPTW) to adjust for confounding. Results: Between January 2015, and December 2022, 41 529 patients were treated with first line pembrolizumab for advanced disease (27 826 male [67.0%]; median [range] age, 65 [19-97] years; 14 835 [35.7%] treated with pembrolizumab alone; 26 694 [64.3%] treated with pembrolizumab plus chemotherapy). At treatment initiation, 12 898 (41.9%) patients were exposed to antibiotics, 18 210 (59.1%) to steroids, and 16 783 (53.7%) to PPIs. After IPTW, antibiotics (except for macrolide and penicillin) were associated with shorter OS (hazard ratio [HR], 1.08; 95% CI, 1.05-1.12; P < .001), but it varied by antibiotic type. Steroids were not associated with OS (HR, 0.98; 95% CI, 0.95-1.02; P = .37); however, there was an interaction with pembrolizumab regimen (ie, pembrolizumab alone or with chemotherapy) (P for interaction < .001), and there was a dose-dependent association according to daily prednisone-equivalent dose (P for trend < .001). Steroids were associated with worse OS when prescribed at doses greater than 20 mg per day for pembrolizumab alone (P for trend = .005) and greater than 30 mg per day for pembrolizumab combined with chemotherapy (P for trend < .001). PPIs were associated with worse OS (HR, 1.13; 95% CI, 1.10-1.17; P < 001). Conclusions and Relevance: In this cohort study of patients with advanced NSCLC treated with pembrolizumab, exposure to some classes of antibiotics, to steroids (>20 mg per day of prednisone equivalent), and to PPIs was associated with worse OS, indicating that comedications should be monitored carefully in patients with immunotherapy.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.