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”.

“The aim is for us all to be able to come together to celebrate research successes and create new connections. I’m certainly looking forward to being able to meet with valued friends and colleagues in the lung cancer community,” said ASM convenor Dr Melissa Moore, medical oncologist at St Vincent’s Hospital, Sydney.

Non-invasive therapy to be trialled in HCC

Researchers in South Australia are set to trial a non-invasive treatment for inoperable early-stage liver cancer.

The SOCRATES (Standard Of Care versus RadioAblaTion in Early Stage HCC ) Study led by Professor Alan Wigg from Flinders University’s College of Medicine and Public Health, aims to test stereotactic ablative body radiotherapy (SABR), against percutaneous ablation.

“Studies have shown the current standard of care is not always successful, with the cancer likely to re-occur in over 30% of cases, and a number of people being unable to access the treatment in the first place, due to the size and position of the tumour,” said Professor Wigg.

“Currently, [radioablation] is considered experimental and only used once first line treatments have failed … However, preliminary research has shown that the treatment has the potential to control tumours with very few adverse events and can reach those that would not be treatable with percutaneous ablation, due to a tumour’s size or difficult location.”

The five-year trial will involve a collaboration between leading hepatologists, radiation oncologists and radiologists across 16 major Australian liver centres.

Professor Wigg said rates of HCC had increased 378% in the last 30 years, the second largest increase of any cancer type, while its mortality rate had the largest increase of any cancer.

“SABR can improve tumour control while at the same time its ability to be delivered in outpatient settings across fewer treatment sessions means it is also likely to be cost-effective and able to be rapidly adopted into clinical practice,” he said.