PPIs raise death risk in advanced NSCLC patients on antitumour therapy

Treatment with proton pump inhibitors (PPI) appears to increase the risk of mortality among patients with advanced nonsmall cell lung cancer (NSCLC) undergoing systemic antitumour therapy, reveals a recent study.

“PPIs are often prescribed to prevent or treat gastrointestinal disease,” according to the investigators, who then went on to explore the association between PPIs and survival outcomes of patients with advanced NSCLS who are on systemic antitumour therapy.

A literature search was conducted in PubMed, Embase, and the Cochrane Library for studies reporting the overall survival (OS) and/or progression-free survival (PFS) of advanced NSCLS patients who are receiving antitumour therapy with or without PPIs, published prior to 31 August 2021.

The investigators conducted a meta-analysis using a random effects model to estimate the hazard ratio (HR) with 95 percent confidence intervals (CIs) and I² to assess statistical heterogeneity. They also performed publication bias and sensitivity analyses.

Fourteen retrospective studies, including a total of 13,709 patients with advanced NSCLS, were included in the meta-analysis.

In subgroup analyses, treatment with PPI was associated with worse OS or PFS of patients receiving chemotherapy, targeted therapy, and immunotherapy (PPI users vs nonusers: HR for OS, 1.35, 95 percent CI, 1.21‒1.51; p<0.00001; HR for PFS, 1.50, 95 percent CI, 1.25‒1.80; p<0.0001).

These findings were found to be robust in both publication bias and sensitivity analyses.

“Until results are further confirmed, caution should be applied when administering PPIs and systemic antitumour therapy to advanced NSCLC patients,” the investigators said.