A common drug used to treat reflux, heartburn and ulcers could decrease the effectiveness of immunotherapy drugs against lung cancer, according to new research from Flinders University.

Lung Cancer: Study Investigated Impact of Proton Pump Inhibitors

Published in Nature’s British Journal of Cancer, the study investigated the impact of proton pump inhibitors (PPIs). This, in patients undergoing treatment for non-small cell lung cancer. The most common type of lung cancer, accounting for 85 percent of cases.

The patients received chemotherapy or were treated with a combination of chemotherapy and atezolizumab. An immune checkpoint inhibitor drug designed to stimulate the immune system to kill cancer cells.

The researchers found that PPI use was associated with poorer survival in advanced cancer patients treated with atezolizumab plus chemotherapy. But not in those who received chemotherapy alone, and the study showed that PPI use was associated with a significant decrease in the benefit of immunotherapy treatment.

Stomach problems and reflux are common in cancer patients

Lead author Dr. Ash Hopkins of the Flinders Health and Medical Research Institute says it is important that the effects of PPIs are well understood.

“Stomach problems and reflux are common in cancer patients. So the use of antacids and proton pump inhibitors is common. About 30 percent of cancer patients use them, and usually for extended periods of time, “says Dr. Hopkins, a research fellow at NHMRC and leader of the Flinders University Laboratory of Clinical Cancer Epidemiology.

“It is concerning that the drug is often used excessively or inappropriately. Since it is considered to cause little harm; however, our research could indicate the need to change this approach. “

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PPIs treat a number of stomach problems

PPIs treat a number of stomach problems by reducing acid production in the stomach wall, with types and brands including esomeprazole (Nexium, Dexilant), lansoprazole (Zoton, Zopral), omeprazole (Losec, Maxor), pantoprazole (Somac , Ozpan) and rabeprazole (Parbezol, Pariet).

Recent studies have shown that the drug can cause significant changes in the gut microbiota, which could lead to its impact on cancer immunotherapy.

“Immune checkpoint inhibitor (ICI) drugs help the immune system by activating T cells, allowing them to kill or control cancerous tumors. But the gut microbiota also plays an important role in regulating our body and its immune function, ”says Dr. Hopkins.

Researchers say it could be time for oncologists to reconsider indiscriminate use of PPIs in their patients

“When this gut microbiota is affected, it can stop the ICI’s ability to activate the immune system. Which means that the drugs just won’t work that well to fight cancer. “

While more studies are needed, the researchers say it might be time for oncologists to reconsider the indiscriminate use of PPIs in their patients.

“With growing evidence that this impact is seen in different types of cancer, as well as the increasing use of PPIs around the world, there is an urgent need to determine conclusively how PPIs are affecting cancer treatment, but the signs are certainly there, ”says Dr. Hopkins.

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