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

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, George W. Sledge, Ami S. Bhatt () and Allison W. Kurian ()
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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
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
Scarlett L. Gomez: University of California San Francisco
Melinda L. Telli: Stanford University School of Medicine
Lidia Schapira: Stanford University School of Medicine
Haruka Itakura: Stanford University School of Medicine
George W. Sledge: Stanford University School of Medicine
Ami S. Bhatt: Stanford University School of Medicine
Allison W. Kurian: Stanford University School of Medicine

Nature Communications, 2023, vol. 14, issue 1, 1-10

Abstract: 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.

Date: 2023
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DOI: 10.1038/s41467-023-37636-0

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