2024-09-25 04:00:19
“We have a number of arguments to say that taking proton pump inhibitors with a certain number of anticancer drugs is a problem, since we will significantly reduce the effectiveness of the latter”asks Jean-Luc Raoul, digestive oncologist at the Western Cancer Institute, in Saint-Herblain (Loire-Atlantique). With Philip Hansten, professor of pharmacology at the University of Washington, he published in July 2024 a bibliographic study in the journal Cancer Treatment Reviews. After studying more than one hundred and fifty scientific articles, and having retained one hundred and eight, the authors warn of this drug interaction which can have effects on the survival of patients.
The anticancer drugs concerned are on the one hand tyrosine kinase inhibitors (TKI), targeted therapies used to treat lung cancer or sarcomas, for example, and on the other hand checkpoint inhibitors, used in immunotherapy.
Proton pump inhibitors (PPIs), such as omeprazole or lansoprazole, help limit stomach acid. They are indicated for stomach or duodenal ulcers, esophagitis or gastroesophageal reflux. They are often prescribed during treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), in order to limit their adverse effects.
“A deleterious association”
PPIs, some of which are available without a prescription, are massively consumed in France. According to one study conducted in 2015around 30% of the population had taken it during the year, and almost half of those over 65. “Many patients are treated chronically, often outside the marketing authorization indications, and sometimes for several years”observes Dominique Deplanque, professor of pharmacology at Lille University Hospital.
“Contrary to what you might think, these are not harmless medications”he insists. “Within the broad topic of drug interactions, PPIs are a special topic, because the impact on the effectiveness of anticancer treatments can be significant”supports Jean-Yves Blay, professor of medical oncology at the Center Léon-Bérard, in Lyon, and president of the Unicancer hospital network, who participated in one of the articles studied by Jean-Luc Raoul.
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In February 2024, French researchers published in the magazine Cancer Treatment and Research Communications a study which also concludes that “deleterious association” between IPP and ITK. They were based on Medicare reimbursement data between 2011 and 2021. In more than thirty-four thousand patients treated with a TKI for so-called “non-small cell” lung cancer, they observed a risk mortality increased if the patient took, in parallel, a PPI for at least 20% of the duration of their cancer treatment. “And the longer the patient was exposed to the PPI-TKI interaction during their TKI cancer treatment, the higher their risk of death was.”specifies Constance Bordet, doctor of pharmacy at the University of Toulouse, and first author of the study. The TKIs studied were erlotinib, gefitinib, afatinib, and osimertinib.
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