“We have a bundle of arguments to say that taking proton pump inhibitors with a certain number of anticancer drugs is a problem, since we will significantly reduce the effectiveness of the latter.”asks Jean-Luc Raoul, digestive oncologist at the Western Cancer Institute in Saint-Herblain (Loire-Atlantique). With Philip Hansten, professor of pharmacology at the University of Washington, he published a bibliographic study in July 2024 in the journal Cancer Treatment ReviewsAfter studying more than one hundred and fifty scientific articles, and having selected one hundred and eight, the authors warn of this drug interaction which can have effects on the survival of patients.
The anticancer drugs concerned are, on the one hand, tyrosine kinase inhibitors (ITKs), targeted therapies used to treat lung cancers or sarcomas, for example, and on the other hand checkpoint inhibitors, used in immunotherapy.
Proton pump inhibitors (PPIs), such as omeprazole or lansoprazole, help limit gastric acidity. They are indicated for stomach or duodenal ulcers, esophagitis or gastroesophageal reflux. They are often prescribed during treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), in order to limit their adverse effects.
“A harmful association”
PPIs, some of which are available without a prescription, are massively consumed in France. According to a study conducted in 2015, around 30% of the population had taken them in the year, and almost half of those over 65. “A large number of patients are treated chronically, often outside the indications of the marketing authorization, and sometimes for several years”observes Dominique Deplanque, professor of pharmacology at the Lille University Hospital.
“Contrary to what one might think, these are not harmless drugs”he insists. “Within the broad topic of drug interactions, PPIs are a special topic, because the impact on the efficacy of anticancer treatments can be significant.”supports Jean-Yves Blay, professor of medical oncology at the Léon-Bérard Center in Lyon, and president of the Unicancer hospital network, who participated in one of the articles studied by Jean-Luc Raoul.
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In February 2024, French researchers published in the journal Cancer Treatment and Research Communications a study which also concludes that “harmful association” between PPI and TKI. They based themselves on data from health insurance reimbursements between 2011 and 2021. Out of more than thirty-four thousand patients treated with an TKI for so-called “non-small cell” lung cancer, they observed an increased risk of mortality if the patient took, in parallel, a PPI for at least 20% of the duration of their cancer treatment. “And the longer the patient was exposed to the PPI-ITK interaction during their ITK cancer treatment, the higher their risk of death.”says Constance Bordet, a doctor of pharmacy at the University of Toulouse and first author of the study. The ITKs studied were erlotinib, gefitinib, afatinib and osimertinib.
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