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Antimicrobial exposure is associated with decreased survival in triple-negative breast cancer

Author

Listed:
  • Julia D. Ransohoff

    (Stanford University School of Medicine)

  • Victor Ritter

    (Stanford University School of Medicine)

  • Natasha Purington

    (Stanford University School of Medicine)

  • Karen Andrade

    (Stanford University School of Medicine)

  • Summer Han

    (Stanford University School of Medicine
    Stanford University School of Medicine
    Stanford University School of Medicine)

  • Mina Liu

    (Stanford University School of Medicine)

  • Su-Ying Liang

    (Palo Alto Medical Foundation Research Institute, Sutter Health)

  • Esther M. John

    (Stanford University School of Medicine
    Stanford University School of Medicine
    Stanford University School of Medicine)

  • Scarlett L. Gomez

    (University of California San Francisco)

  • Melinda L. Telli

    (Stanford University School of Medicine
    Stanford University School of Medicine)

  • Lidia Schapira

    (Stanford University School of Medicine
    Stanford University School of Medicine)

  • Haruka Itakura

    (Stanford University School of Medicine)

  • George W. Sledge

    (Stanford University School of Medicine
    Stanford University School of Medicine)

  • Ami S. Bhatt

    (Stanford University School of Medicine
    Stanford University School of Medicine)

  • Allison W. Kurian

    (Stanford University School of Medicine
    Stanford University School of Medicine
    Stanford University School of Medicine)

Abstract

Antimicrobial exposure during curative-intent treatment of triple-negative breast cancer (TNBC) may lead to gut microbiome dysbiosis, decreased circulating and tumor-infiltrating lymphocytes, and inferior outcomes. Here, we investigate the association of antimicrobial exposure and peripheral lymphocyte count during TNBC treatment with survival, using integrated electronic medical record and California Cancer Registry data in the Oncoshare database. Of 772 women with stage I-III TNBC treated with and without standard cytotoxic chemotherapy – prior to the immune checkpoint inhibitor era – most (654, 85%) used antimicrobials. Applying multivariate analyses, we show that each additional total or unique monthly antimicrobial prescription is associated with inferior overall and breast cancer-specific survival. This antimicrobial-mortality association is independent of changes in neutrophil count, is unrelated to disease severity, and is sustained through year three following diagnosis, suggesting antimicrobial exposure negatively impacts TNBC survival. These results may inform mechanistic studies and antimicrobial prescribing decisions in TNBC and other hormone receptor-independent cancers.

Suggested Citation

  • Julia D. Ransohoff & Victor Ritter & Natasha Purington & Karen Andrade & Summer Han & Mina Liu & Su-Ying Liang & Esther M. John & Scarlett L. Gomez & Melinda L. Telli & Lidia Schapira & Haruka Itakura, 2023. "Antimicrobial exposure is associated with decreased survival in triple-negative breast cancer," Nature Communications, Nature, vol. 14(1), pages 1-10, December.
    • Handle: RePEc:nat:natcom:v:14:y:2023:i:1:d:10.1038_s41467-023-37636-0
    DOI: 10.1038/s41467-023-37636-0
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    References listed on IDEAS

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    2. Hein Putter & Hans C. Houwelingen, 2017. "Understanding Landmarking and Its Relation with Time-Dependent Cox Regression," Statistics in Biosciences, Springer;International Chinese Statistical Association, vol. 9(2), pages 489-503, December.
    3. Rick L. Williams, 2000. "A Note on Robust Variance Estimation for Cluster-Correlated Data," Biometrics, The International Biometric Society, vol. 56(2), pages 645-646, June.
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