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Long-Term Use of Proton Pump Inhibitors in Cancer Patients: An Opinion Paper

SIMPLE SUMMARY: Proton pump inhibitors are frequently used in cancer patients to alleviate some symptoms, epigastric pain or heartburn. However, acid suppression decreases the absorption of some oral-targeted anticancer treatments (tyrosine kinase inhibitors, CDK4/6 inhibitors) and induces changes i...

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Autores principales: Raoul, Jean-Luc, Edeline, Julien, Simmet, Victor, Moreau-Bachelard, Camille, Gilabert, Marine, Frénel, Jean-Sébastien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8909698/
https://www.ncbi.nlm.nih.gov/pubmed/35267464
http://dx.doi.org/10.3390/cancers14051156
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author Raoul, Jean-Luc
Edeline, Julien
Simmet, Victor
Moreau-Bachelard, Camille
Gilabert, Marine
Frénel, Jean-Sébastien
author_facet Raoul, Jean-Luc
Edeline, Julien
Simmet, Victor
Moreau-Bachelard, Camille
Gilabert, Marine
Frénel, Jean-Sébastien
author_sort Raoul, Jean-Luc
collection PubMed
description SIMPLE SUMMARY: Proton pump inhibitors are frequently used in cancer patients to alleviate some symptoms, epigastric pain or heartburn. However, acid suppression decreases the absorption of some oral-targeted anticancer treatments (tyrosine kinase inhibitors, CDK4/6 inhibitors) and induces changes in the gut microbiome. Recent data are showing that these interactions have important clinical impacts and medical oncologists and patients must be aware of these possible interactions. ABSTRACT: Multikinase inhibitors (MKIs), and particularly tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (CPIs), are currently some of the major breakthroughs in cancer treatment. Proton pump inhibitors (PPIs) revolutionised the treatment of acid-related diseases, but are frequently overused for epigastric pain or heartburn. However, long-term acid suppression from using PPIs may lead to safety concerns, and could have a greater impact in cancer patients undergoing therapy, like bone fractures, renal toxicities, enteric infections, and micronutrient deficiencies (iron and magnesium). Moreover, acid suppression may also affect the pharmacokinetics of drugs (at least during acid suppression) and decrease the absorption of many molecularly-targeted anticancer therapies, which are mostly weak bases with pH-dependent absorption. This type of drug-drug interaction may have detrimental effects on efficacy, with major clinical impacts described for some orally administrated targeted therapies (erlotinib, gefitinib, pazopanib, palbociclib), and conflicting results with many others, including capecitabine. Furthermore, the long-term use of PPIs results in severe alterations to the gut microbiome and recent retrospective analyses have shown that the benefit of using CPIs was suppressed in patients treated with PPIs. These very expensive drugs are of great importance because of their efficacy. As the use of PPIs is not essential, we must apply the precautionary principle. All these data should encourage medical oncologists to refrain from prescribing PPIs, explaining to patients the risks of interaction in order to prevent inappropriate prescription by another physician.
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spelling pubmed-89096982022-03-11 Long-Term Use of Proton Pump Inhibitors in Cancer Patients: An Opinion Paper Raoul, Jean-Luc Edeline, Julien Simmet, Victor Moreau-Bachelard, Camille Gilabert, Marine Frénel, Jean-Sébastien Cancers (Basel) Review SIMPLE SUMMARY: Proton pump inhibitors are frequently used in cancer patients to alleviate some symptoms, epigastric pain or heartburn. However, acid suppression decreases the absorption of some oral-targeted anticancer treatments (tyrosine kinase inhibitors, CDK4/6 inhibitors) and induces changes in the gut microbiome. Recent data are showing that these interactions have important clinical impacts and medical oncologists and patients must be aware of these possible interactions. ABSTRACT: Multikinase inhibitors (MKIs), and particularly tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (CPIs), are currently some of the major breakthroughs in cancer treatment. Proton pump inhibitors (PPIs) revolutionised the treatment of acid-related diseases, but are frequently overused for epigastric pain or heartburn. However, long-term acid suppression from using PPIs may lead to safety concerns, and could have a greater impact in cancer patients undergoing therapy, like bone fractures, renal toxicities, enteric infections, and micronutrient deficiencies (iron and magnesium). Moreover, acid suppression may also affect the pharmacokinetics of drugs (at least during acid suppression) and decrease the absorption of many molecularly-targeted anticancer therapies, which are mostly weak bases with pH-dependent absorption. This type of drug-drug interaction may have detrimental effects on efficacy, with major clinical impacts described for some orally administrated targeted therapies (erlotinib, gefitinib, pazopanib, palbociclib), and conflicting results with many others, including capecitabine. Furthermore, the long-term use of PPIs results in severe alterations to the gut microbiome and recent retrospective analyses have shown that the benefit of using CPIs was suppressed in patients treated with PPIs. These very expensive drugs are of great importance because of their efficacy. As the use of PPIs is not essential, we must apply the precautionary principle. All these data should encourage medical oncologists to refrain from prescribing PPIs, explaining to patients the risks of interaction in order to prevent inappropriate prescription by another physician. MDPI 2022-02-24 /pmc/articles/PMC8909698/ /pubmed/35267464 http://dx.doi.org/10.3390/cancers14051156 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Raoul, Jean-Luc
Edeline, Julien
Simmet, Victor
Moreau-Bachelard, Camille
Gilabert, Marine
Frénel, Jean-Sébastien
Long-Term Use of Proton Pump Inhibitors in Cancer Patients: An Opinion Paper
title Long-Term Use of Proton Pump Inhibitors in Cancer Patients: An Opinion Paper
title_full Long-Term Use of Proton Pump Inhibitors in Cancer Patients: An Opinion Paper
title_fullStr Long-Term Use of Proton Pump Inhibitors in Cancer Patients: An Opinion Paper
title_full_unstemmed Long-Term Use of Proton Pump Inhibitors in Cancer Patients: An Opinion Paper
title_short Long-Term Use of Proton Pump Inhibitors in Cancer Patients: An Opinion Paper
title_sort long-term use of proton pump inhibitors in cancer patients: an opinion paper
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8909698/
https://www.ncbi.nlm.nih.gov/pubmed/35267464
http://dx.doi.org/10.3390/cancers14051156
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