Li Chao, Xia Zhengzheng, Li Anna, Meng Jun
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Guangdong, Shenzhen, China.
Ann Transl Med. 2020 Dec;8(24):1655. doi: 10.21037/atm-20-7498.
Proton pump inhibitors (PPIs) are commonly prescribed for preventing and treating gastrointestinal ulcers. In patients with advanced cancer, it is unclear whether concomitant use of immune checkpoint inhibitors (ICIs) and PPIs could result in poorer outcomes. This study investigates the impact of PPIs on the survival of cancer patients treated with ICIs.
PubMed, MEDLINE, EMBASE, and the Cochrane Library databases were searched from January 1, 1970 to June 2, 2020 for studies reporting the prognoses of cancer patients receiving antitumor therapies including ICIs with or without PPIs. The primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS), respectively. Hazard ratios (HRs) with a 95% confidence interval (CI) were reported to express the effectiveness of ICIs in PPI users compared to non-PPI users, using a random effects model.
Five studies were identified comprising 1,167 cancer patients. Concomitant use of PPIs with ICIs did not result in statistically significant changes in OS (HR 0.996; 95% CI: 0.486-1.447) and PFS (HR 0.858; 95% CI: 0.388-1.328). Statistical testing suggested heterogeneity among studies. Sensitivity analyses confirmed the stability of our results.
Concomitant ICI-PPI therapy does not appear to be significantly associated with OS or PFS, and further research on the effect of individual ICIs in different cancer patients is needed.
质子泵抑制剂（PPIs）常用于预防和治疗胃肠道溃疡。在晚期癌症患者中，免疫检查点抑制剂（ICIs）与PPIs联合使用是否会导致更差的预后尚不清楚。本研究调查了PPIs对接受ICIs治疗的癌症患者生存的影响。
检索1970年1月1日至2020年6月2日期间的PubMed、MEDLINE、EMBASE和Cochrane图书馆数据库，以查找报告接受包括ICIs在内的抗肿瘤治疗（无论是否使用PPIs）的癌症患者预后的研究。主要和次要终点分别为总生存期（OS）和无进展生存期（PFS）。采用随机效应模型，报告了95%置信区间（CI）的风险比（HRs），以表达ICIs在PPI使用者与非PPI使用者中的有效性。
共纳入5项研究，包括1167例癌症患者。PPIs与ICIs联合使用在OS（HR 0.996；95%CI：0.486 - 1.447）和PFS（HR 0.858；95%CI：0.388 - 1.328）方面未产生统计学上的显著变化。统计学检验表明各研究间存在异质性。敏感性分析证实了我们结果的稳定性。
ICI-PPI联合治疗似乎与OS或PFS无显著相关性，需要进一步研究不同癌症患者中个别ICIs的效果。
