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Almansour SA, Alqudah MAY, Abuhelwa Z, Al-Shamsi HO, Semreen MH, Bustanji Y, Soare NC, McKinnon RA, Sorich MJ, Hopkins AM, Abuhelwa AY. Association of proton pump inhibitor use with survival and adverse effects outcomes in patients with multiple myeloma: pooled analysis of three clinical trials. Sci Rep 2024; 14:591. [PMID: 38182614 PMCID: PMC10770405 DOI: 10.1038/s41598-023-48640-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024] Open
Abstract
Proton pump inhibitors (PPIs) are commonly used in cancer patients, but their impact on treatment outcomes in multiple myeloma (MM) patients remains unclear. This study investigated the association of PPI use with survival and adverse effects in MM patients across three randomized-control trials initiating daratumumab, lenalidomide, or bortezomib combination treatments. Cox proportional hazard analysis and logistic regression were employed to assess the associations with treatment outcomes, while adjusting for age, sex, weight, MM international staging system stage, ECOG-performance status, comorbidity count, and presence of gastrointestinal disorders. Pooled data involving 1804 patients revealed that 557 (32%) used PPIs at baseline. PPI use was independently associated with worse overall survival (adjusted HR [95% CI] 1.32 [1.08-1.62], P = 0.007) and grade ≥ 3 adverse events (adjusted OR [95% CI] 1.39 [1.03-1.88], P = 0.030). However, the association with progression-free survival did not reach statistical significance (adjusted HR [95% CI] 1.14 [0.97-1.33], P = 0.112). Findings were consistent across trials and treatment arms. PPI use was identified as a negative prognostic factor in MM patients, potentially enhancing clinical decisions regarding its use. Further research is needed to fully comprehend the impacts and safety of PPI use in MM patients.
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Affiliation(s)
- Sara A Almansour
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohammad A Y Alqudah
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ziad Abuhelwa
- Department of Hematology and Medical Oncology, University of South Florida/ H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Humaid O Al-Shamsi
- Department of Oncology, Burjeel Cancer Institute, Burjeel Medical City, P.O. Box 92510, Abu Dhabi, United Arab Emirates
- Emirates Oncology Society, P.O.Box: 6600, Dubai, United Arab Emirates
- Gulf Medical University, P.O. Box: 4184, Ajman, United Arab Emirates
- Gulf Cancer Society, P.O. Box 26733, 13128, Alsafa, Kuwait
| | - Mohammad H Semreen
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Medicinal Chemistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Yasser Bustanji
- College of Medicine, University of Sharjah, P. O. Box 27272, Sharjah, United Arab Emirates
- School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Nelson C Soare
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Medicinal Chemistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Ross A McKinnon
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michael J Sorich
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ashley M Hopkins
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ahmad Y Abuhelwa
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates.
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
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Lee JE, Kwon SH, Kwon S, Jung HI, Nam JH, Lee EK. Concomitant Use of Proton Pump Inhibitors and Palbociclib Among Patients With Breast Cancer. JAMA Netw Open 2023; 6:e2324852. [PMID: 37477917 PMCID: PMC10362477 DOI: 10.1001/jamanetworkopen.2023.24852] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/08/2023] [Indexed: 07/22/2023] Open
Abstract
Importance Proton pump inhibitors (PPIs) are commonly used drugs to relieve gastrointestinal tract symptoms, but their acid-inhibitory action negatively affects the bioavailability and clinical outcomes of orally administered concomitant drugs. Objective To identify the clinical outcomes of patients with advanced breast cancer who concomitantly use PPIs and palbociclib. Design, Setting, and Participants This retrospective cohort study used nationwide claims data between November 1, 2016, and July 31, 2021, in South Korea. Patients with breast cancer receiving palbociclib between November 1, 2017, and July 31, 2020, were identified. Patients whose prescriptions for palbociclib and PPI overlapped by at least 33% were classified into a concomitant PPI group. Patients who never received PPI during the palbociclib treatment period were classified into a nonconcomitant PPI group. Patients were selected through 1:3 propensity score matching for analyses. Exposures Concomitant use of PPIs with palbociclib. Main Outcomes and Measures Time to progression and death. These outcomes were presented as progression-free survival (PFS) and overall survival (OS) and were analyzed using the Kaplan-Meier method and log-rank test. Cox proportional hazards regression was used to estimate the hazard ratio (HR) of concomitant PPI use associated with clinical PFS and/or OS. Results A total of 344 women were included in the concomitant PPI group and 966 in the nonconcomitant PPI group. Among 1310 patients identified after matching, 1108 (84.6%) were older than 50 years; 1111 (84.8%) were treated with letrozole and anastrozole (endocrine sensitive); and 199 (15.2%) were treated with fulvestrant (endocrine resistant). The median clinical PFS in the concomitant PPI group was shorter than that of the nonconcomitant PPI group (25.3 [95% CI, 19.6-33.0] vs 39.8 [95% CI, 34.9 to not applicable] months; P < .001), and the HR was 1.76 (95% CI, 1.46-2.13). Concomitant use of PPI was also associated with shorter OS (HR, 2.71 [95% CI, 2.07-3.53]). Both clinical PFS and OS in the concomitant PPI group were consistently poor in patients receiving endocrine-sensitive and endocrine-resistant treatment. Conclusions and Relevance These findings suggest that concomitant use of PPIs with palbociclib may hinder the complete therapeutic benefits of palbociclib in patients with breast cancer.
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Affiliation(s)
- Ju-Eun Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Swan Kwon
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Hye-In Jung
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Jin Hyun Nam
- Division of Big Data Science, Korea University Sejong Campus, Sejong, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
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Piao XM, Byun YJ, Zheng CM, Song SJ, Kang HW, Kim WT, Yun SJ. A New Treatment Landscape for RCC: Association of the Human Microbiome with Improved Outcomes in RCC. Cancers (Basel) 2023; 15:cancers15030935. [PMID: 36765892 PMCID: PMC9913391 DOI: 10.3390/cancers15030935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Microbes play different roles in metabolism, local or systemic inflammation, and immunity, and the human microbiome in tumor microenvironment (TME) is important for modulating the response to immunotherapy in cancer patients. Renal cell carcinoma (RCC) is an immunogenic tumor, and immunotherapy is the backbone of its treatment. Correlations between the microbiome and responsiveness to immune checkpoint inhibitors have been reported. This review summarizes the recent therapeutic strategies for RCC and the effects of TME on the systemic therapy of RCC. The current understanding and advances in microbiome research and the relationship between the microbiome and the response to immunotherapy for RCC are also discussed. Improving our understanding of the role of the microbiome in RCC treatment will facilitate the development of microbiome targeting therapies to modify the tumor microbiome and improve treatment outcomes.
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Affiliation(s)
- Xuan-Mei Piao
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Young Joon Byun
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Chuang-Ming Zheng
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Sun Jin Song
- Department of Emergency, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea
| | - Ho Won Kang
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea
| | - Seok Joong Yun
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea
- Correspondence: ; Tel.: +82-43-269-6142
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Del Re M, Crucitta S, Omarini C, Bargagna I, Mongillo M, Palleschi M, Stucci S, Meattini I, D'Onofrio R, Lorenzini G, Biondani P, De Giorgi U, Porta C, Livi L, Natalizio S, Fontana A, Giontella E, Angelini L, Fogli S, Danesi R. Concomitant administration of proton pump inhibitors does not significantly affect clinical outcomes in metastatic breast cancer patients treated with ribociclib. Breast 2022; 66:157-161. [PMID: 36283134 PMCID: PMC9593796 DOI: 10.1016/j.breast.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Gastric pH changes by proton-pump-inhibitors (PPIs) were found to affect progression-free survival (PFS) in metastatic breast cancer (mBC) patients treated with palbociclib. The current study was aimed at investigating whether the same effect could occur in patients treated with ribociclib. PATIENTS AND METHODS Patients with hormone-positive/HER-2-negative mBC candidates for first-line treatment with ribociclib were enrolled in this retrospective-cohort study. Patients were classified as "no concomitant PPIs" or "concomitant PPIs"; PPI administration covered the entire or not less than 2/3 of treatment with ribociclib. All clinical interventions were made according to clinical practice. RESULTS A total of 128 patients were consecutively enrolled in the study; 78 belonged to the "no concomitant PPIs" group and 50 to the "concomitant PPIs" group. One hundred and six patients were endocrine-sensitive and received ribociclib and letrozole, while 22 were endocrine-resistant and were treated with ribociclib and fulvestrant. The most prescribed PPI was lansoprazole. According to PFS, patients taking PPIs had a PFS almost superimposable to those assuming ribociclib and endocrine therapy alone (35.3 vs. 49.2 months, p = 0.594). No difference in PFS was observed in estrogen-sensitive or estrogen-resistant mBC in the presence or absence of concomitant PPI treatment (p = 0.852). No correlation with adverse events was found including grade>2 hematological toxicities. CONCLUSIONS The present study supports the hypothesis that the concomitant use of PPIs does not compromise the efficacy of ribociclib in a real-life setting.
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Affiliation(s)
- Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Irene Bargagna
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Italy
| | - Marta Mongillo
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust of Verona, Italy
| | - Michela Palleschi
- Unit of Medical Oncology, IRCCS-Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, Meldola, Italy
| | - Stefania Stucci
- Division of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences ‘M. Serio’, University of Florence, Italy,Radiation Oncology Unit e Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Giulia Lorenzini
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Italy
| | - Pamela Biondani
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust of Verona, Italy
| | - Ugo De Giorgi
- Unit of Medical Oncology, IRCCS-Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, Meldola, Italy
| | - Camillo Porta
- Division of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences ‘M. Serio’, University of Florence, Italy,Radiation Oncology Unit e Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Andrea Fontana
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Italy
| | - Elena Giontella
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust of Verona, Italy
| | - Lucia Angelini
- Department of Experimental and Clinical Biomedical Sciences ‘M. Serio’, University of Florence, Italy,Radiation Oncology Unit e Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Stefano Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Italy,Corresponding author. Department of Clinical and Experimental Medicine, Via Roma, 55, 56126, Pisa, Italy.
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Deluce J, Maleki Vareki S, Fernandes R. The role of gut microbiome in immune modulation in metastatic renal cell carcinoma. Ther Adv Med Oncol 2022; 14:17588359221122714. [PMID: 36105887 PMCID: PMC9465582 DOI: 10.1177/17588359221122714] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Treatment of metastatic renal cell carcinomas (mRCC) has drastically improved
since the advent of immunotherapy with immune checkpoint inhibitors (ICIs), with
a significant proportion of patients achieving durable responses. While this has
revolutionized treatment and improved outcomes for mRCC patients, a large subset
of patients still does not respond to treatment with ICIs. Moreover, ICIs can
induce various immune-related adverse events, limiting their use in many
patients. Therefore, there is a need to identify the predictive biomarkers of
both efficacy and toxicity associated with ICIs, which would allow for a more
personalized approach and help with clinical decision-making. This review aims
to explore the role of the gut microbiome in RCC to overcome primary resistance
and predict response to treatment with ICIs. First, current therapeutic
strategies and mechanisms of action of ICI therapies for RCC treatment will be
reviewed. With the technological development of shotgun whole-genome sequencing,
the gut microbiome has emerged as an exciting field of research within oncology.
Thus, the role of the microbiome and its bidirectional interaction with ICIs and
other drugs will be explored, with a particular focus on the microbiome profile
in RCC. Lastly, the rationale for future clinical interventions to overcome
resistance to ICIs using fecal microbiota transplantation in patients with RCC
will be presented.
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Affiliation(s)
- Jasna Deluce
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Saman Maleki Vareki
- Division of Experimental Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, CanadaDepartment of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London Regional Cancer Program, Room A4-130A, Cancer Research Laboratory Program, London, ON N6A 3K7, Canada.Cancer Research Laboratory Program, Lawson Health Research Institute, London, ON, Canada
| | - Ricardo Fernandes
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, 800 Commissioners Road East, Room A3-940, London ON N6A 5W9, Canada.Cancer Research Laboratory Program, Lawson Health Research Institute, London, ON, Canada
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