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Review | Open Access

The effect of concomitant drugs on oncological outcomes in patients treated with immunotherapy for metastatic urothelial carcinoma: a narrative review

MICHELE MAFFEZZOLI#,1,2, GIULIA CLAIRE GIUDICE#,1,2( ), GIACOMO IOVANE1,2, MARTINA MANINI1,2, ELENA RAPACCHI1, GIUSEPPE CARUSO1, NICOLA SIMONI3, STEFANIA FERRETTI4, STEFANO PULIATTI4, DAVIDE CAMPOBASSO5, SEBASTIANO BUTI1,2
Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
Department of Medicine and Surgery, University of Parma, Parma, 43126, Italy
Radiotherapy Unit, University Hospital of Parma, Parma, 43126, Italy
Department of Urology, University of Modena and Reggio Emilia, Modena, 41124, Italy
Urology Unit, University Hospital of Parma, Parma, 43126, Italy

#These two authors contributed equally to this work

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Abstract

Background

immune checkpoint inhibitors (ICIs) have revolutionized the treatment of metastatic urothelial carcinoma (mUC), significantly improving survival outcomes. However, a subset of patients do not respond to ICIs, prompting research into potential predictive factors. Commonly prescribed medications such as corticosteroids, proton-pump inhibitors (PPIs), antibiotics (Abs), antihypertensives, and analgesics may influence ICI effectiveness.

Methods

we conducted a literature search on PubMed to investigate the impact of concomitant medications on the outcomes of patients with mUC, treated with ICIs. We selected the most relevant studies and performed a narrative review.

Results

corticosteroids, PPIs and Abs have been associated with reduced survival in ICI-treated patients, including those with mUC. In contrast, antihypertensive agents like renin-angiotensin system inhibitors and beta-blockers may enhance ICI efficacy, though evidence remains inconclusive. The impact of other medications, such as statins, metformin, and analgesics, on ICI outcomes is less clear, with some data suggesting a detrimental impact on immune response.

Conclusions

this narrative review synthesizes current evidence on how concomitant medications affect outcomes in mUC patients treated with ICIs.

Keywords

Immune checkpoint inhibitors (ICIs)Urothelial carcinoma (UC)Concomitant drugsProton pump inhibitorsAntibiotics (Abs)Angiotensin-converting enzyme inhibitors (ACEIs)

References

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Oncology Research
Volume 33 Issue 4,
April 2025
Pages 741-757
DOI: 10.32604/or.2024.057278

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Cite this article:
MAFFEZZOLI M, GIUDICE GC, IOVANE G, et al. The effect of concomitant drugs on oncological outcomes in patients treated with immunotherapy for metastatic urothelial carcinoma: a narrative review. Oncology Research, 2025, 33(4): 741-757. https://doi.org/10.32604/or.2024.057278

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Received: 13 August 2024
Accepted: 04 November 2024
Published: 30 April 2025
© The Author 2024.

This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.