PPIs but not antibiotics hinder immune therapy
Further evidence has emerged to suggest that proton pump inhibitors may reduce the efficacy of immune checkpoint inhibitors.
A review of data from five RCTs (IMpower130, IMpower131, IMpower150, OAK and POPLAR) evaluating atezolizumab in advanced non-small cell lung cancer found that recent PPI use was associated with inferior OS and PFS efficacy. However, there was no evidence that participants who recently used an antibiotic had any reduction in atezolizumab efficacy.
In the pooled cohort of 4,458 participants with advanced NSCLC, the OS efficacy (HR 95% CI of atezolizumab vs comparator arms) was 1.00 for PPI users, compared to 0.76 for PPI non-users. Similarly the PFS efficacy was 0.93 vs 0.75, respectively, and the PPI effect was consistent across all trials. The study also identified PPI use being associated with lower pre-treatment counts of lymphocytes, CD19+ and CD16+CD56+ peripheral blood immune cells.
“Given approximately 30% of cancer patients use PPIs, there is an urgent need for evidence on the impacts of PPIs on the efficacy of other ICIs and for guidelines on the use of PPIs in patients considering ICIs,” said the study authors led by Dr Ash Hopkins from the Flinders Health and Medical Research Institute, Adelaide.
“Specifically, guidelines may consider calling for a review of PPI use prior to ICI initiation, and if no appropriate indication for PPI use is identified, consideration to ceasing the PPI may be warranted — this recommendation is based on research indicating that PPIs are overprescribed by up to 70%, seemingly from a perspective that they will do no harm.”
The findings are published in the Journal of Thoracic Oncology.
Lung cancer meeting scheduled for July
The Thoracic Oncology Group of Australasia (TOGA) will hold a face-to-face Annual Scientific Meeting in Sydney this July.
Scheduled for Thursday 21 to Friday 22 July, the meeting will be in a hybrid format and registrations will be available for in-person and online attendance.
According to TOGA, the meeting “will provide an opportunity to connect and collaborate with leaders from across the lung cancer community including science and research, respiratory medicine, medical oncology, radiation oncology, radiology, pathology, nursing, allied health, and patient involvement in research”.