H pylori May Undermine Immunotherapy Response in Gastric Cancer

The study was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Patients with advanced gastric cancer who have active Helicobacter pylori infections were less likely to respond to anti-PD-1 antibody therapy than H pylori–negative patients.

  • Those with active H pylori infections also demonstrated shorter progression-free survival (PFS) and overall survival (OS).

Why This Matters

  • Overall, patients with advanced gastric cancer do not respond well to immune checkpoint inhibitors.

  • Prognostic markers are needed to identify those patients who will and those who will not respond.

  • These findings suggest that active H pylori infection could be one such marker.

Study Design

  • In this small retrospective study, investigators compared the response of advanced gastric cancer to anti-PD-1 antibodies in 34 patients who had active H pylori infections with that of 43 patients who did not.

  • Of the 77 patients, 43 received nivolumab, 29 received pembrolizumab, and five received camrelizumab/toripalimab/tislelizumab.

Key Results

  • The H pylori–positive group had an almost threefold greater risk of nonclinical response (odds ratio [OR], 2.91).

  • The H pylori–negative group demonstrated longer median PFS (8.4 vs 2.7 months; hazard ratio [HR], 3.11) and OS (17.5 vs 6.2 months; HR, 2.85).

  • On multivariate regression, active H pylori infection was independently associated with shorter PFS (HR, 1.90) but not shorter OS (HR, 1.76; 95% CI, 0.99 – 3.12).


  • The study was a small, retrospective investigation.

  • Data on other prognostic factors — PD-L1 positivity, high microsatellite instability, and Epstein-Barr virus infection — were not included in the multivariate regression analysis.


  • No funding for the study was reported. The authors have disclosed relevant financial relationships.

This is a summary of a preprint research study, “Association of Helicobacter pylori Infection With Survival Outcomes in Advanced Gastric Cancer Patients Treated With Immune Checkpoint Inhibitors,” led by Hebin Che of the Chinese PLA General Hospital. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and an MIT Knight Science Journalism fellow. Email: [email protected].

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