Rizzo Alessandro, Santoni Matteo, Mollica Veronica, Ricci Angela Dalia, Calabrò Concetta, Cusmai Antonio, Gadaleta-Caldarola Gennaro, Palmiotti Gennaro, Massari Francesco
Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico "Don Tonino Bello", Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Istituto Tumori Giovanni Paolo II-Bari, Viale Orazio Flacco 65, 70124 Bari, Italy.
Oncology Unit, Macerata Hospital, 62100 Macerata, Italy.
J Pers Med. 2022 May 20;12(5):842. doi: 10.3390/jpm12050842.
Immune checkpoint inhibitors (ICIs) have recently represented a breakthrough in urothelial carcinoma (UC). Proton pump inhibitors (PPIs) are routinely used for extended time periods in UC patients, with these agents having potentially and frequently undervalued effects on ICIs efficacy.
We performed a meta-analysis aimed at investigating the impact of concomitant PPI administration on progression-free survival (PFS) and overall survival (OS) among patients receiving immunotherapy for metastatic UC.
Two studies encompassing a total of 1015 patients were included. The pooled Hazard Ratios (HRs) for OS and PFS were 1.55 (95% CI, 1.31-1.84) and 1.43 (95% CI, 1.23-1.66), respectively, suggesting that the administration of PPIs was negatively associated with PFS and with OS in UC patients treated with ICIs.
The current meta-analysis represents the first study to provide a systematic evaluation of the impact of concomitant PPI use in UC patients treated with ICIs. Further studies are warranted on this topic to clarify the relationship between gut microbiome, antiacid exposure, and cancer immunotherapy. In the current era of medical oncology, progress in this setting will require the collaboration of basic science and clinical research to optimize systemic treatment and to improve the outcomes of UC patients receiving ICIs.
免疫检查点抑制剂（ICI）最近在尿路上皮癌（UC）治疗方面取得了突破。质子泵抑制剂（PPI）在UC患者中经常被长期使用，这些药物对ICI疗效的潜在影响常常被低估。
我们进行了一项荟萃分析，旨在研究在接受转移性UC免疫治疗的患者中，同时使用PPI对无进展生存期（PFS）和总生存期（OS）的影响。
纳入了两项研究，共1015例患者。OS和PFS的合并风险比（HR）分别为1.55（95%CI，1.31 - 1.84）和1.43（95%CI，1.23 - 1.66），这表明在接受ICI治疗的UC患者中，使用PPI与PFS和OS呈负相关。
当前的荟萃分析是第一项对在接受ICI治疗的UC患者中同时使用PPI的影响进行系统评估的研究。关于这一主题有必要进一步开展研究，以阐明肠道微生物群、抗酸暴露和癌症免疫治疗之间的关系。在当前肿瘤医学时代，这方面的进展将需要基础科学和临床研究的合作，以优化全身治疗并改善接受ICI治疗的UC患者的治疗效果。
