Gut medication may be hindering lung cancer treatment
A common medication used to treat reflux, heartburn and ulcers could be lessening the effectiveness of lung cancer immunotherapy drugs, according to a new study conducted by Flinders University and published in the British Journal of Cancer.
Proton pump inhibitors (PPIs) treat a number of stomach issues by reducing acid production in the wall of the stomach, with types and brands including esomeprazole (Nexium, Dexilant), lansoprazole (Zoton, Zopral), omeprazole (Losec, Maxor), pantoprazole (Somac, Ozpan) and rabeprazole (Parbezol, Pariet). The new study investigated the impact of PPIs on patients undergoing treatment for non-small-cell lung cancer, which accounts for 85% of lung cancer cases; patients received either chemotherapy or a combination of chemotherapy and atezolizumab, an immune checkpoint inhibitor drug designed to boost the immune system into killing cancer cells.
The researchers found PPI use was associated with worse survival in patients with advanced cancer treated with atezolizumab plus chemotherapy, but not in those who received chemotherapy alone. They suspect that this is due to the fact that PPIs can cause significant gut microbiota changes, which could impact cancer immunotherapy.
“Immune checkpoint inhibitor (ICI) drugs help the immune system by switching on T cells, allowing them to kill or control cancerous tumours, but the gut microbiota also plays an important role in regulating our body and its immune function,” said lead author Dr Ash Hopkins, from the Flinders Health and Medical Research Institute.
“When this gut microbiota is impacted it can stop the ability of ICIs to activate the immune system, meaning the drugs simply won’t work as well to fight off the cancer.”
Dr Hopkins noted that stomach issues and reflux are common in cancer patients, so antacids and PPIs are often prescribed — usually for extended periods of time. With the new study indicating that this may be causing more harm than good, the researchers say it could be time for oncologists to reconsider indiscriminate use of PPIs for their patients.
“With increasing evidence this impact is seen across different cancer types, as well as the growing use of PPIs around the world, there is an urgent need to conclusively determine how PPIs are affecting cancer treatment, but the signs are certainly there,” Dr Hopkins said.
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