PPI use affects outcomes in urothelial cancer treated with atezolizumab
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PPI use affects outcomes in urothelial cancer treated with atezolizumab Use of proton-pump inhibitors (PPIs) is associated with worse survival outcomes in urothelial cancer treated with atezolizumab, but not chemotherapy, according to a study from Australia. The study evaluated the association between PPI use and survival outcomes with atezolizumab, as compared to chemotherapy, in patients with advanced urothelial carcinoma using pooled data from two contemporary clinical trials: IMvigor210, a single-arm atezolizumab trial (n = 429); and IMvigor211, a phase III randomised trial of atezolizumab versus chemotherapy (n = 931). Of the 429 patients within IMvigor210, 141 (33%) received a PPI between 30 days prior and 30 days after atezolizumab initiation; in IMvigor211, 145 (31%) of the 467 patients randomised to atezolizumab received a PPI within the 60-day window. Cox proportional hazard analysis showed that in the pooled group of patients allocated to atezolizumab, PPI use was associated with significantly worse overall survival (OS; hazard ratio [HR] 1.52, 95% CI 1.27–1.83), significantly worse progression-free survival (PFS; HR 1.38; 95% CI 1.18–1.62) and significantly worse objective response (HR 0.51, 95% CI 0.32–0.82). There was no association between PPI use and OS, PFS or objective response in patients randomised to chemotherapy in IMvigor211. Further analysis of IMvigor211 showed that PPI use was associated with a statistical decrease in the magnitude of OS and PFS benefit from atezolizumab. "Given approximately 30% of patients with cancer use PPIs, often for extended time periods, there is an urgent need to conclusively determine if PPIs influence [immune checkpoint inhibitor] efficacy," conclude the researchers. Hopkins AM, et al. Concomitant Proton Pump Inhibitor Use and Survival in Urothelial Carcinoma Treated with Atezolizumab. Clinical Cancer Research : 15 Sep 2020. 803503373 Available from: URL: https://doi.org/10.1158/1078-0432.CCR-20-1876
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Reactions 26 Sep 2020 No. 1823
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