Proton Pump Inhibitors and Survival Outcomes in Patients With Metastatic Renal Cell Carcinoma: Beyond the Abstract

In this study, we conducted a pooled analysis of randomized clinical trials to investigate the effect of proton pump inhibitor (PPI) use on survival in 2,188 patients with metastatic RCC (mRCC) treated in the targeted therapy era.

Our primary objective was to compare overall survival (OS) between PPI users (defined as receiving a PPI at baseline) vs nonusers. Secondary objectives were to compare progression-free survival (PFS), objective response rates (ORR), and adverse events between both groups.

We found that OS was not significantly different between PPI users and nonusers. Similarly, PFS and ORR were not different between both groups and these findings were consistent across IMDC risk groups and line of therapy. Adverse events, either all grade or grade 3-5, were also comparable between both groups. Ultimately, our analysis shows that PPI use does not appear to negatively affect the efficacy of select oral targeted therapies – including sunitinib, axitinib, and sorafenib.

The clinical implication of this work is to highlight the importance of medicine reconciliation and patient education on concomitant medications, in order to optimize the efficacy and safety of oral targeted therapies in this setting. This is particularly essential in the context of the growing number of oral agents available to treat mRCC, the increasing incidence of polypharmacy, and the risk of drug interactions with an aging population.

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Written By:
Aly-Khan A. Lalani MD