ArticleJournal for immunotherapy of cancer2020
Integrated analysis of concomitant medications and oncological outcomes from PD-1/PD-L1 checkpoint inhibitors in clinical practice.
Article in Journal for immunotherapy of cancer, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 167 papers, 19 of them syntheses that pooled it.
What it found
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Who cites it
167 citing papers in PubMed, 19 syntheses or guidelines pooled it, 255 citations in OpenAlex.
- Renin-angiotensin system inhibitors and immunotherapy outcomes in lung cancer: a systematic review and meta-analysis with complementary transcriptomic analyses.Frontiers in immunology · 2026Pooled it
- Concomitant anticoagulants and the survival of cancer patients treated with immune checkpoint inhibitors: a meta-analysis.Scientific reports · 2025Pooled it
- Pooled it
- Impact of beta blockers on cancer neuroimmunology: a systematic review and meta-analysis of survival outcomes and immune modulation.Frontiers in immunology · 2025Pooled it
- Assessing the impact of probiotics on immunotherapy effectiveness and antibiotic-mediated resistance in cancer: a systematic review and meta-analysis.Frontiers in immunology · 2025Pooled it
- Do corticosteroids affect immunotherapy efficacy in malignancy? - A systematic review.Cancer medicine · 2024Pooled it
- Concomitant use of renin-angiotensin system inhibitors augments the efficacy of immune checkpoint inhibitors: a systematic review and meta-analysis.Frontiers in pharmacology · 2024Pooled it
- Acid suppressants reduce the therapeutic effect of immune checkpoint inhibitors and increase the risk of acute kidney injury: a meta-analysis.International journal of clinical oncology · 2023Pooled it
- The negative impact of opioids on cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis.Journal of cancer research and clinical oncology · 2023Pooled it
- Effect of renin-angiotensin-aldosterone system inhibitors on survival outcomes in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis.Frontiers in immunology · 2023Pooled it
- Do proton pump inhibitors alter the response to immune checkpoint inhibitors in cancer patients? A meta-analysis.Frontiers in immunology · 2023Pooled it
- Statin shapes inflamed tumor microenvironment and enhances immune checkpoint blockade in non-small cell lung cancer.JCI insight · 2022Pooled it
- Effect of proton pump inhibitors on the clinical outcomes of PD-1/PD-L1 inhibitor in solid cancer patients.Medicine · 2022Pooled it
- Intestinal microbiota signatures of clinical response and immune-related adverse events in melanoma patients treated with anti-PD-1.Nature medicine · 2022Pooled it
- Statins Are Associated with Improved Survival of Patients with Gastric Cancer: A Systematic Review and Meta-Analysis.International journal of clinical practice · 2022Pooled it
- Effect of Concomitant Use of Analgesics on Prognosis in Patients Treated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis.Frontiers in immunology · 2022Pooled it
- An Up-To-Date Investigation Into the Correlation Between Proton Pump Inhibitor Use and the Clinical Efficacy of Immune Checkpoint Inhibitors in Advanced Solid Cancers: A Systematic Review and Meta-Analysis.Frontiers in oncology · 2022Pooled it
- Pooled it
- Effects of concomitant proton pump inhibitor use on immune checkpoint inhibitor efficacy among patients with advanced cancer.Oncoimmunology · 2021Pooled it
- Early and High-Dose Glucocorticoid Use and Survival in Advanced NSCLC Receiving Immune Checkpoint Inhibitors: A Multicenter Target Trial Emulation.Clinical pharmacology and therapeutics · 2026Observational
107 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
40 authors at 20 institutions in 2 countries.
Funding
Abstract
backgroundConcomitant medications, such as steroids, proton pump inhibitors (PPI) and antibiotics, might affect clinical outcomes with immune checkpoint inhibitors.
methodsWe conducted a multicenter observational retrospective study aimed at evaluating the impact of concomitant medications on clinical outcomes, by weighing their associations with baseline clinical characteristics (including performance status, burden of disease and body mass index) and the underlying causes for their prescription. This analysis included consecutive stage IV patients with cancer, who underwent treatment with single agent antiprogrammed death-1/programmed death ligand-1 (PD-1/PD-L1) with standard doses and schedules at the medical oncology departments of 20 Italian institutions. Each medication taken at the immunotherapy initiation was screened and collected into key categories as follows: corticosteroids, antibiotics, gastric acid suppressants (including proton pump inhibitors - PPIs), statins and other lipid-lowering agents, aspirin, anticoagulants, non-steroidal anti-inflammatory drugs (NSAIDs), ACE inhibitors/Angiotensin II receptor blockers, calcium antagonists, β-blockers, metformin and other oral antidiabetics, opioids.
resultsFrom June 2014 to March 2020, 1012 patients were included in the analysis. Primary tumors were: non-small cell lung cancer (52.2%), melanoma (26%), renal cell carcinoma (18.3%) and others (3.6%). Baseline statins (HR 1.60 (95% CI 1.14 to 2.25), p=0.0064), aspirin (HR 1.47 (95% CI 1.04 to 2.08, p=0.0267) and β-blockers (HR 1.76 (95% CI 1.16 to 2.69), p=0.0080) were confirmed to be independently related to an increased objective response rate. Patients receiving cancer-related steroids (HR 1.72 (95% CI 1.43 to 2.07), p<0.0001), prophylactic systemic antibiotics (HR 1.85 (95% CI 1.23 to 2.78), p=0.0030), prophylactic gastric acid suppressants (HR 1.29 (95% CI 1.09 to 1.53), p=0.0021), PPIs (HR 1.26 (95% CI 1.07 to 1.48), p=0.0050), anticoagulants (HR 1.43 (95% CI: 1.16 to 1.77), p=0.0007) and opioids (HR 1.71 (95% CI 1.28 to 2.28), p=0.0002) were confirmed to have a significantly higher risk of disease progression. Patients receiving cancer-related steroids (HR 2.16 (95% CI 1.76 to 2.65), p<0.0001), prophylactic systemic antibiotics (HR 1.93 (95% CI 1.25 to 2.98), p=0.0030), prophylactic gastric acid suppressants (HR 1.29 (95% CI 1.06 to 1.57), p=0.0091), PPI (HR 1.26 (95% CI 1.04 to 1.52), p=0.0172), anticoagulants (HR 1.45 (95% CI 1.14 to 1.84), p=0.0024) and opioids (HR 1.53 (95% CI 1.11 to 2.11), p=0.0098) were confirmed to have a significantly higher risk of death.
conclusionWe confirmed the association between baseline steroids administered for cancer-related indication, systemic antibiotics, PPIs and worse clinical outcomes with PD-1/PD-L1 checkpoint inhibitors, which can be assumed to have immune-modulating detrimental effects.
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