Proton Pump Inhibitors in cancer patients: How useful they are? A review of the most common indications for their use

Numico, Gianmauro; Fusco, Vittorio; Franco, Pierfrancesco; Roila, Fausto

doi:10.1016/j.critrevonc.2017.01.014

Cited by 59 publications

(46 citation statements)

References 83 publications

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“…In this context, a recent review suggested that the gastric toxicity of chemotherapy should be managed in the same way as other (e.g. haematological) toxicities and should not automatically lead to pharmacological prophylaxis . Interestingly, we did not identify an increase in endoscopy act according to PPIs new use.…”

Section: Discussioncontrasting

confidence: 58%

Is there overuse of proton pump inhibitors in B‐cell non‐Hodgkin lymphomas? A cohort study based on the French health insurance database in the Midi‐Pyrénées region

Conte

Bourrel

Despas

et al. 2019

Fundamemntal Clinical Pharma

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Patients suffering from B‐cell non‐Hodgkin lymphomas (B‐NHL) have an increased likelihood of being exposed to proton pump inhibitors (PPIs), related to several factors which have been reported in the literature. PPIs are among the drugs most likely to be prescribed inappropriately. Consequently, B‐NHL patients could be particularly at risk of inappropriate PPI prescription, with potential adverse drug reactions. We aimed to evaluate the incidence of PPIs use and to identify factors associated with PPIs initiation during the active treatment phase of B‐NHL. We conducted a new‐user cohort study using regional data from the French national health insurance database in the Midi‐Pyrénées region (southwestern France). Incident B‐NHL patients were selected according to an algorithm of selection, validated with data from a cancer registry. Our study revealed that 48.9% (95% confidence interval [CI]: 45.2–52.6) of patients initiated PPIs during chemotherapy after B‐NHL diagnosis. According to information available in the SNDS, recommended indications for PPI prescriptions were identified in 21.1% of cases. Median duration of treatment was 65.3 days (CI: 35–112). Determinants of PPIs initiation were peptic ulcer disease, gastroprotection (appropriate or not) for medications considered at risk (NSAIDs, glucocorticoids and anticoagulants), age, nonfollicular lymphoma, polypharmacy, gastroenterologists’ consultations and being hospitalized in a university hospital. Around 50% of patients initiated PPI treatment during the chemotherapy phase with only one‐fifth identified as appropriate prescriptions and with long durations of treatment in most cases. Given this background, appropriate PPI prescription should be promoted in B‐NHL to avoid potential inappropriate chronic use and related adverse events.

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Section: Discussioncontrasting

confidence: 58%

Is there overuse of proton pump inhibitors in B‐cell non‐Hodgkin lymphomas? A cohort study based on the French health insurance database in the Midi‐Pyrénées region

Conte

Bourrel

Despas

et al. 2019

Fundamemntal Clinical Pharma

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“…The spectrum of damage to the gastric mucosa includes diffuse gastritis, superficial erosions and ulcers. Most of these patients will also have severe thrombocytopenia …”

Section: Literature Reviewmentioning

confidence: 99%

“…Numico et al 2017 reviewed five previous studies that performed serial endoscopy on haematology and oncology patients receiving non‐intensive chemotherapy, using a variety of presumed gastroprotective therapies (misoprostol, H2 receptor antagonist and PPI therapy) versus no prophylaxis. They concluded that while there was a reduction in macroscopic evidence of mucositis with PPI therapy, mucosal damage was usually superficial and there was no overall change in clinical outcomes, including GI bleeding, anaemia and perforation . We are not aware of any trials specifically looking at the effect of PPI prophylaxis on endoscopic appearances or bleeding in patients receiving intensive chemotherapy and with severe mucositis.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The most pertinent potential short‐term toxicities in the haematology patient population are pneumonia and gut‐derived bacteraemia. Although the data are not conclusive, several studies have found a relationship between increased hospital‐ and community‐acquired pneumonia in hospital inpatients, particularly with PPI doses greater than 40 mg pantoprazole daily . A retrospective review of 92 haematology inpatients post chemotherapy found that 70% of patients with gut‐derived bacteraemia were on PPI therapy compared with 48% without bacteraemia, but confounding factors could not be excluded .…”

Section: Literature Reviewmentioning

confidence: 99%

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Is there a role for proton pump inhibitor prophylaxis in haematology patients?

Leitinger

Hui

Grigg

2019

Internal Medicine Journal

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While proton pump inhibitors (PPI) are widely prescribed as prophylaxis in selected haematology inpatient and outpatients, an informal survey of haematology units around Australia found wide variations in the specific indications for their use. This is consistent with a literature review which showed a paucity of robust evidence to support their use, specifically in chemotherapy‐induced mucositis, thrombocytopenia or administration of high dose glucocorticosteroids in the absence of additional risk factors. Rationalising PPI prescribing is clinically important from both a cost and safety perspective, given the emerging evidence of adverse events associated with prolonged PPI administration. A review of prescribing practices at our institution over a 14‐month period found that approximately 60% of myeloma, lymphoma and autograft patients received PPI prophylaxis during and beyond chemotherapy without an accepted indication. We encourage institutions to review their PPI prescribing practices with the intent of rationalising their use, and to conduct studies aiming to fill the substantial gaps in our knowledge.

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“…4 Unfortunately, patients with STS often require ASMs, such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs), for various diagnoses. 6 Clinicians are, therefore, faced with the challenge of managing PAZ drug interactions in clinical practice. Options include separating the administration of PAZ from the ASM or to reduce the dose of ASM.…”

Section: Acid-suppressive Strategies and Pazopanib In Stsmentioning

confidence: 99%

Effect of Acid‐Suppressive Strategies on Pazopanib Efficacy in Patients With Soft‐Tissue Sarcoma

Pisano

Hoffman

Legasto

et al. 2019

Clinical Translational Sci

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Pazopanib (PAZ), a tyrosine kinase inhibitor used in the treatment of soft tissue sarcoma (STS), should not be administered with acid‐suppressive medications (ASMs) due to decreased drug solubility. Common practice for patients requiring ASM with PAZ is to separate administration by 12 hours; however, there is little real‐world evidence describing clinical outcomes using this strategy. The aim of this study was to determine whether concomitant ASM impacted efficacy and adverse event rates in patients with STS receiving PAZ. Medical records were retrospectively reviewed for patients with STS who received PAZ from June 2011 to July 2017. Patients were stratified into two groups, PAZ with or without ASM (PAZ + ASM or PAZ only). The primary objective was to determine whether progression‐free survival (PFS) differed between groups. Secondary objectives were to determine overall survival (OS) and occurrence of grade 3/4 toxicities. Ninety‐one patients were included in the study, 42 patients in the PAZ + ASM group and 49 in the PAZ only group. Median PFS was significantly shorter in the PAZ + ASM group than the PAZ only group (5.3 vs. 6.7 months). The PAZ + ASM group also had a 74% higher relative risk of progression or death than the PAZ only group, but there was no difference in OS. Regarding adverse events, the PAZ + ASM group trended toward lower levels of grade 3/4 hypertension (19% vs. 37%). These results suggest that ASM should be avoided in patients with STS receiving PAZ. Larger studies are needed to further elucidate the impact of ASM use with PAZ in clinical practice.

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Proton Pump Inhibitors in cancer patients: How useful they are? A review of the most common indications for their use

Cited by 59 publications

References 83 publications

Is there overuse of proton pump inhibitors in B‐cell non‐Hodgkin lymphomas? A cohort study based on the French health insurance database in the Midi‐Pyrénées region

Is there overuse of proton pump inhibitors in B‐cell non‐Hodgkin lymphomas? A cohort study based on the French health insurance database in the Midi‐Pyrénées region

Is there a role for proton pump inhibitor prophylaxis in haematology patients?

Effect of Acid‐Suppressive Strategies on Pazopanib Efficacy in Patients With Soft‐Tissue Sarcoma

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