Abstract
Introduction
Proton pump inhibitors (PPIs) are potent inhibitors of gastric acid secretion and
can affect the optimal absorption of concomitant oral medications, such as vascular
endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKIs). The purpose of
this study was to investigate the effect of PPI use on survival in metastatic renal
cell carcinoma (mRCC) patients treated in the targeted therapy era.
Materials and Methods
We conducted a pooled analysis of mRCC patients treated in phase II and III clinical
trials. Statistical analyses were performed using Cox regression adjusted for several
risk factors and the Kaplan–Meier method.
Results
We identified 2188 patients treated with sunitinib (n = 952), axitinib (n = 626) or
sorafenib (n = 610), of whom 120 were PPI users. Overall, PPI users showed similar
overall survival compared with non-PPI users (hazard ratio [HR], 1.051; 95% confidence
interval [CI], 0.769-1.438; P = .754; median, 24.1 vs. 21.3 months). Similarly, progression-free survival (HR,
1.016; 95% CI, 0.793-1.301; P = .902; median, 5.5 vs. 8.0 months) and objective response rates (23.3% vs. 27.4%;
P = .344) were not different between PPI users and nonusers. These findings were consistent
across International mRCC Database Consortium risk groups and according to line of
therapy. Adverse events were similar between PPI users and nonusers.
Conclusion
We showed that PPI use does not appear to negatively affect the efficacy and safety
of select VEGF-TKIs in patients with mRCC. Documentation of concomitant medications
and patient education on potential drug interactions are critical for optimizing the
use of oral cancer-targeting therapy.
Keywords
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Article info
Publication history
Published online: May 31, 2017
Accepted:
May 16,
2017
Received in revised form:
May 8,
2017
Received:
March 2,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
