Evidence map›Paper›PMID 41827802›Full record

ReviewCancers2026

A Silent Saboteur of Immunotherapy: Antibiotic Use and Its Impact on Immune Checkpoint Inhibitors Efficacy, a Systematic Review and Meta-Analysis of Recent Studies.

Giuliana Ciappina, Enrica Toscano, Giordana Di Mauro, Tindara Franchina, Francesca Basile, Gianluca Vanni, Gaetano Facchini, Guglielmo Nasti, Vincenzo Quagliariello, Nicola Maurea and 5 more

Abstract readReview
In one paragraph

Review in Cancers, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Giuliana CiappinaDepartment of Medical Sciences, Section of Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.ORCID 0000-0003-0813-3126
Enrica ToscanoDivision of Medical Oncology, "G. Martino" University Hospital, University of Messina, 98124 Messina, Italy.ORCID 0009-0003-2362-764X
Giordana Di MauroSchool of Specialization in Medical Oncology, Department of Human Pathology "G. Barresi", University of Messina, 98122 Messina, Italy.
Tindara FranchinaDepartment of Human Pathology of Adulthood and Childhood "G. Barresi", University of Messina, 98122 Messina, Italy.
Francesca BasileSchool of Specialization in Medical Oncology, Department of Human Pathology "G. Barresi", University of Messina, 98122 Messina, Italy.
Gianluca VanniBreast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, 00133 Rome, Italy.
Gaetano FacchiniDivision of Oncology, Santa Maria delle Grazie Hospital, Azienda Sanitaria Locale Napoli 2 Nord, 80078 Pozzuoli, Italy.
Guglielmo NastiDivision of Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy.
Vincenzo QuagliarielloDivision of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy.
Nicola MaureaDivision of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy.ORCID 0000-0003-3704-0092
Mariapia MarafiotiSchool of Specialization in Medical Oncology, Department of Human Pathology "G. Barresi", University of Messina, 98122 Messina, Italy.ORCID 0009-0007-8807-6163
Antonio BottariRadiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98124 Messina, Italy.
Oreste Claudio BuonomoBreast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, 00133 Rome, Italy.
Alessandro OttaianoDivision of Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy.ORCID 0000-0002-2901-3855
Massimiliano BerrettaDivision of Medical Oncology, "G. Martino" University Hospital, University of Messina, 98124 Messina, Italy.ORCID 0000-0002-9837-9148

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundImmune checkpoint inhibitors (ICIs) have transformed the management of solid tumors, yet only a subset of patients achieve durable benefit. The gut microbiota is a key modulator of antitumor immunity, and systemic antibiotic therapy (ABT), frequently prescribed-and sometimes overused-in oncology, can profoundly disrupt microbial homeostasis. Observational studies suggest that ABT may impair ICI efficacy, but results remain heterogeneous, warranting an updated synthesis.

methodsWe conducted a systematic review and meta-analysis in accordance with the PRISMA 2020 guidelines. PubMed, Scopus, and EMBASE were searched for studies published between 2018 and 2025 evaluating the association between ABT exposure and time-to-event outcomes in patients with solid tumors treated with ICIs. Studies were required to report explicit definition of the ABT exposure window. Random-effects models were considered primary. A sensitivity analysis was performed in non-small cell lung cancer (NSCLC).

resultsFifteen studies encompassing 52,489 patients were included. ABT exposure was associated with significantly worse OS (random-effects HR 1.16, 95% CI 1.03-1.29) and PFS (random-effects HR 1.11, 95% CI 0.95-1.27), indicating an increased risk of death and disease progression compared with no ABT exposure. In the NSCLC sensitivity analysis, ABT was consistently associated with inferior PFS and, when accounting for heterogeneity, with significantly reduced OS, supporting the robustness of the association.

conclusionsABT administered in temporal proximity to ICIs is associated with clinically meaningful worsening of survival outcomes across solid tumors, consistent with microbiome-mediated impairment of immunotherapy efficacy. These findings support cautious ABT stewardship in patients receiving ICIs and highlight the need for prospective studies integrating microbiome profiling and standardized ABT exposure assessment.

Indexed as

antibiotic therapygut microbiotaimmune checkpoint inhibitorsmeta-analysisnon-small cell lung cancer

Identifiers

PMID41827802
PMCPMC12984459

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Registered trials

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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 OpenQuestion graph.