TY - JOUR
T1 - Routine antibiotics in the febrile cancer patient
T2 - Should immune checkpoint inhibitors affect our practice?
AU - Walker, Katie
AU - Yu, Kathryn
AU - Choong, Zhi Shyuan Seraphina
AU - Loupis, Anne
AU - Richardson, Gary
N1 - Funding Information:
Funding The Cabrini Research Institute has been funded by Roche, Bristol Myers Squibb, Merck & Co and AstraZenica for clinical trials investigating Immune checkpoint inhibitors.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Patients with cancer often attend emergency departments, with the most common presenting complaint being fever. Many of these patients receive antibiotics to treat possible sepsis, particularly when they are receiving chemotherapy. Immune checkpoint inhibitors are a relatively new cancer treatment option, especially for tumour types such as melanoma, renal cell carcinoma and non-small cell lung cancer. There is increasing evidence that exposure to antibiotics blocks the therapeutic action of checkpoint inhibitors, reducing response rates, increasing disease progression and decreasing overall survival rates. The effect is most marked when antibiotics are given prior to the commencement of the checkpoint inhibitors. Emergency medicine prescribes a lot of courses of antibiotics to this group of patients. It is important for emergency physicians to be aware of this association and the potential for antibiotics to be worsening long-term patient outcomes. There are many causes of fevers in oncology patients, with only some patients experiencing bacterial sepsis when presenting to emergency departments. Research on how to determine who should and shouldn't receive antibiotics is needed, perhaps leading to risk stratification guidelines. It would be good in future to avoid unnecessary antibiotics in those patients who are eligible for immunotherapy.
AB - Patients with cancer often attend emergency departments, with the most common presenting complaint being fever. Many of these patients receive antibiotics to treat possible sepsis, particularly when they are receiving chemotherapy. Immune checkpoint inhibitors are a relatively new cancer treatment option, especially for tumour types such as melanoma, renal cell carcinoma and non-small cell lung cancer. There is increasing evidence that exposure to antibiotics blocks the therapeutic action of checkpoint inhibitors, reducing response rates, increasing disease progression and decreasing overall survival rates. The effect is most marked when antibiotics are given prior to the commencement of the checkpoint inhibitors. Emergency medicine prescribes a lot of courses of antibiotics to this group of patients. It is important for emergency physicians to be aware of this association and the potential for antibiotics to be worsening long-term patient outcomes. There are many causes of fevers in oncology patients, with only some patients experiencing bacterial sepsis when presenting to emergency departments. Research on how to determine who should and shouldn't receive antibiotics is needed, perhaps leading to risk stratification guidelines. It would be good in future to avoid unnecessary antibiotics in those patients who are eligible for immunotherapy.
KW - Emergency medicine
KW - immunotherapy
KW - Sepsis
KW - Gastrointesinal microbiome
KW - Neoplasm
UR - http://www.scopus.com/inward/record.url?scp=85091895402&partnerID=8YFLogxK
U2 - 10.1136/emermed-2020-210224
DO - 10.1136/emermed-2020-210224
M3 - Editorial
C2 - 32948622
AN - SCOPUS:85091895402
VL - 38
SP - 85
EP - 86
JO - Emergency Medicine Journal
JF - Emergency Medicine Journal
SN - 1472-0205
IS - 1
ER -