Open Access

REVIEW

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 IOVANE^1,2, MARTINA MANINI^1,2, ELENA RAPACCHI¹, GIUSEPPE CARUSO¹, NICOLA SIMONI³, STEFANIA FERRETTI⁴, STEFANO PULIATTI⁴, DAVIDE CAMPOBASSO⁵, SEBASTIANO BUTI^1,2

1 Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
2 Department of Medicine and Surgery, University of Parma, Parma, 43126, Italy
3 Radiotherapy Unit, University Hospital of Parma, Parma, 43126, Italy
4 Department of Urology, University of Modena and Reggio Emilia, Modena, 41124, Italy
5 Urology Unit, University Hospital of Parma, Parma, 43126, Italy

* Corresponding Author: GIULIA CLAIRE GIUDICE. Email:
# These two authors contributed equally to this work

(This article belongs to the Special Issue: Advances in Cancer Immunotherapy)

Oncology Research 2025, 33(4), 741-757. https://doi.org/10.32604/or.2024.057278

Received 13 August 2024; Accepted 04 November 2024; Issue published 19 March 2025

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

---