Probiotic supplement exposure and outcomes of patients with non-small cell lung cancer treated with first-line atezolizumab therapy: Pooled analysis of individual patient data from five randomized control trials
Menée à partir des données de 5 essais randomisés incluant 3 600 patients atteints d'un cancer du poumon non à petites cellules et recevant un traitement de première ligne par atézolizumab, cette étude analyse l'effet d'une supplémentation en probiotiques sur la survie sans progression et la survie globale
Introduction: Previous evidence suggests that probiotics might play a prognostic role in patients with non-small cell lung cancer (NSCLC) undergoing immune checkpoint blockade, with their impact being influenced by the use of antibiotics.
Patients and Methods: We conducted a patient-level cross-trial analysis of five randomized controlled trials that evaluated the efficacy of first-line atezolizumab therapy in NSCLC. Using forest plot analysis, we examined whether exposure to probiotic supplement affected progression-free survival (PFS) and overall survival (OS) in both atezolizumab-treated and non-atezolizumab-treated cohorts. Analyses were performed on the overall population as well as stratified by antibiotic use, aiming to validate the differential prognostic role of probiotic supplement in patients with and without antibiotic exposure emerged from earlier observational studies. Probiotic supplement and antibiotic use within 42 days before and after treatment initiation was examined. To avoid the immortal time bias, patients with a survival follow-up ≤ 42 days were excluded.
Results: Among 3,600 patients, 2.2% (80/3,600) were exposed to probiotic supplement, while 30.2% (1,086/3,600) were exposed to antibiotics. Probiotic supplement use was not associated with significant differences in PFS or OS in either the atezolizumab or non-atezolizumab groups, across the overall population as well as subgroups stratified by antibiotic exposure. Moreover, the interaction terms between probiotic supplement use and treatment modality (atezolizumab vs. non-atezolizumab) were not statistically significant in analyses of patients with and without antibiotic exposure.
Conclusion: No significant association between probiotic supplement exposure and outcomes of patients receiving immunotherapy was observed, but further study is warranted.
Lung Cancer , résumé, 2025