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The following is a summary of “Impact of concomitant medications on the oncologic efficacy of systemic therapy in patients with advanced or metastatic urothelial carcinoma: a systematic review and meta-analysis,” published in the April 2025 issue of BMC Urology by Tsuboi et al.
Immune checkpoint inhibitors (ICI) and chemotherapy, including antibody-drug conjugates, were commonly used to treat advanced unresectable or metastatic urothelial carcinoma (UC), with most older adults (OAs) also receiving medications for comorbid conditions.
Researchers conducted a retrospective study to analyze how concomitant medications influenced oncological outcomes in individuals with advanced unresectable or metastatic UC receiving systemic therapy.
They performed a review in August 2024 by searching 3 datasets for studies that examined concomitant medications in individuals with advanced unresectable or metastatic UC. The review protocol was registered in PROSPERO (CRD42024547335). Overall survival (OS) was defined as the primary outcome. Depending on the degree of heterogeneity observed, either a fixed-effects or random-effects model was applied for the meta-analysis.
The results showed that 16 eligible studies with 4,816 patients were identified. Concomitant medications commonly reported include proton pump inhibitors (PPIs), antibiotics, steroids, and opioids. The use of concomitant PPIs (hazard ratios (HR): 1.43, 95% CI: 1.31–1.57, P< 0.001), antibiotics (HR: 1.2, 95% CI: 1.04–1.38, P= 0.01), steroids (HR: 1.45, 95% CI: 1.25–1.67, P< 0.001), and opioids (HR: 1.74, 95% CI: 1.46–2.07, P< 0.001) during ICI therapy was associated with worsened OS. However, concomitant antibiotic use during chemotherapy did not impact OS (HR: 1.01, 95% CI: 0.67–1.51).
Investigators concluded that when administering ICI therapy for advanced unresectable or metastatic UC, caution regarding concurrent medications like PPIs and antibiotics was necessary to prevent potential reductions in ICI efficacy.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-025-01754-2
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