Clostridioides difficile infection (CDI) was associated with increased risk for intensive care unit (ICU) admission and mortality among patients with lung cancer. These findings were published in OncoTargets and Therapy.

A common concern in the cancer setting is CDI, and some studies have suggested that epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) treatment may increase risk for CDI.

As EGFR-TKIs are often used to treat lung cancer, this study was designed to evaluate the prevalence and outcomes of CDIin the lung cancer setting. For this retrospective study, medical records from 2242 patients with lung cancer who received EGFR-TKIs and had diarrhea between 2011 and 2019 were reviewed for risk factors and outcomes of CDI. Patients were identified through the Chang Gung Research Database (CGRD) and treated at centers in Taiwan.


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Fifty-one patients developed CDI (CDI cohort) and 2191 patients did not (control cohort). Patients in the CDI and control cohorts were mean ages 66.5 and 65.4 years, 64.7% and 60.9% were women, and 68.6% and 75.0% were treatment-naïve at baseline, respectively.

Risk for CDI was associated with systemic steroid (adjusted odds ratio [aOR], 4.90; P <.001) and antibiotic (aOR, 3.30; P =.001) use in the 6 months prior to the index date (date of EGFR-TKI initiation). Compared with afatinib, gefitinib and erlotinib tended to be associated with higher CDI risk (aOR, 1.81; 95% CI, 0.94-3.47; P =.075).

Patients who had CDI were at increased risk for ICU admission (adjusted hazard ratio [aHR], 5.98; P <.001) and mortality (aHR, 2.34; P <.001).

These findings may not be generalizable as the CGRD population tends to have more severe disease.

Among EGFR-TKI recipients with lung cancer, risk for CDI was associated with prior systematic steroid and antibiotic use, and development of CDI associated with poorer clinical outcomes.

Reference

Chung Y-S, Lin Y-C, Hung M-S, Ho M-C, Fang Y-H. Clinical Impact of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Associated Clostridioides difficile Infection Among Patients with Lung Cancer. Onco Targets Ther. 2022;15:1563-1571. doi:10.2147/OTT.S386807