PPI use and cancer care
Although issues exist with PPIs in respect to cancer therapies, there are some strategies which may help reduce possible negative effects, Dr. Patel said. “When PPI medications are prescribed, they should be used at the lowest effective dose for the shortest necessary duration, and their use should be regularly reevaluated for dose reduction and/or potential discontinuation.”
Dr. Patel noted that, based on the indication for PPIs, alternatives to PPIs should be considered in the setting of potential drug-drug interactions that may affect the efficacy of oral cancer therapies. “For example, for intermittent typical reflux symptoms such as heartburn, over-the-counter antacids may be considered, along with reflux lifestyle medications,” he explained.
Likewise, the study authors stated in their research letter that “PPIs should be actively identified and substituted” in certain cases. The authors added that antacids are also the best option for patients taking checkpoint inhibitors.
“For those patients who absolutely must take TKI and PPI, clinicians can also consider staggering the dosing schedule, such as taking the TKI in the morning at least 2 hours before PPI and/or with an acidic beverage,” added Dr. Patel.
Although the findings from this study raise potential concerns, Dr. Patel stated further clinical investigations are needed to help the medical community better understand the specific effects of PPIs on the efficacy of various chemotherapeutic agents and to also help develop better management options for patients in these settings.
The authors reported relationships with Bayer, Merck, Transgene, and others. Dr. Patel has no relevant conflicts of interest to report.