PPIs may impair efficacy of checkpoint inhibitors

Proton pump inhibitors (PPIs) may reduce the effectiveness of some immune checkpoint inhibitors (ICI) by causing gut dysbiosis, Australian researchers say.

A retrospective review of outcomes for 1202 lung cancer participants in the IMPower150 trial of immunotherapies found that PPI use was independently associated with worse Overall Survival (Hazard 1.53 [1.21–1.95], P < 0.001) and Progression Free Survival (1.34 [1.12–1.61], P = 0.002) in patients treated with atezolizumab.

PPI use also had a negative effect in patients treated with atezolizumab and bevacizumab plus carboplatin plus paclitaxel (BCP), but not BCP alone.

Lead author Dr Ash Hopkins from the Flinders Health and Medical Research Institute, Adelaide, said it was important to understand the impacts of PPIs since about 30% of cancer patients use them, and usually for extended periods of time.

“Of concern is that the medication is often overused, or used inappropriately, as it is seen to cause little harm, however our research could indicate a need to change this approach,” said Dr Hopkins, a NHMRC Investigator Fellow and leader of the Clinical Cancer Epidemiology Lab at Flinders University.

He suggested the effect may be mediated via the gut microbiota as it plays an important role in regulating immune function.

Action needed on adjuvant bisphosponates in EBC

Australia should follow the UK’s example in order to have adjuvant bisphosphonates (BPs) adopted into standard clinical practice for early breast cancer, NSW oncologist Dr Isobel Porter says

While a adjuvant BPs are now almost universally prescribed in the UK for post-menopausal women with early breast cancer to reduce recurrence and mortality, the uptake in Australia is less than 50%, she writes in the Journal of Bone Oncology.

Australian oncologists cited barriers such as cost and uncertainty about evidence of benefit despite BPs being recommended in international guidelines, she noted.

While MOGA was trying to make a business case for funding of BPs, she said other measures could be adopted based on successful UK model. These could include, raising awareness of the adjuvant BPs benefits by engaging with the oncology community (oncology conferences etc); encouraging the discussion of adjuvant BPs in local breast cancer MDT meetings; working with national bodies to produce clear guidelines for the use of adjuvant BPs in early breast cancer; working with breast cancer charities to raise awareness among patients, and lobbying decision makers.

“If we are able to address the major barriers of cost, physician awareness and local protocol guidance, this would lead to more optimal management of Australian women with early breast cancer and allow their oncologists to conform to international practice,” she wrote.

Transparency register to reveal surgeon outcomes

A bill that will require surgeons and hospitals to be transparent about their surgical performance outcomes on a public register has had its second reading in Senate.

The Health Insurance Legislation Amendment (Transparent Patient Outcomes) Bill 2021 will establish Transparent Patient Outcomes registers for a range of medical specialties such as plastic, reconstructive and orthopaedic surgery, which its proponents say will allow consumers to make informed choices after viewing the performance of individual practitioners and patient outcomes for procedures they are poised to undergo.

Speaking on 23 November, Senator Stirling Griff said the transparency register will include information such as the number and type of surgical procedures performed by a practitioner, their surgical revision rate, their patient mortality rate, any prosthesis device they may use, patient data and any other information deemed relevant to that specialty. This information would also be available at the facility level.

“Such a database would provide objective comparable statistics and would provide prospective patients factual information through which they could exercise greater self-determination in their choice of practitioner (rather than relying on trust, assurance or referrals) and the database could also serve to reassure an anxious patient,” he said.