de Moraes Francisco Cezar Aquino, de Laia Estella Aparecida, Sano Vitor Kendi Tsuchiya, Dos Santos Aline Gabriele Etur, Pereira Caroline R M, Burbano Rommel Mario Rodríguez
Oncology Research Center, University Hospital João de Barros Barreto, Belém, Brazil.
Department of Medicine, Fluminense Federal University, Rio de Janeiro, Brazil.
Expert Rev Clin Pharmacol. 2025 Jan-Feb;18(1-2):67-75. doi: 10.1080/17512433.2024.2443183. Epub 2025 Jan 25.
Colorectal cancer is the second leading cause of cancer-related deaths worldwide. The impact of proton pump inhibitors (PPIs) on patients taking capecitabine, an oral fluoropyrimidine, remains uncertain, despite their use by 20 to 55% of cancer patients. We investigated how PPIs affect the effectiveness of capecitabine in treating colorectal cancer.
We searched PubMed, Embase, and Web of Science databases for studies that investigated the use of PPI with capecitabine versus capecitabine alone. We used random-effects models for all endpoints. Heterogeneity was assessed using I statistics.
We included 676 patients receiving capecitabine monotherapy. The overall progression/disease-free survival favored the PPI non-users (HR 2.1372; 95% CI 1.4591-3.1306; < 0.001). Our results show that there seems to be no difference between users of PPIs and capecitabine in the colorectal cancer patients (HR 1.5922; 95% CI 0.9718-2.6086; = 0.065). However, after sensitivity-adjusted analysis, PPI use was negatively associated with PPI use (HR 2.14; 95% CI 1.14-4.01; < 0.001).
Patients with colorectal cancer undergoing oral chemotherapy, specifically capecitabine, should be monitored for the use of PPIs. Therefore, the use of PPIs should be discouraged in clinical practice in these cases.
www.crd.york.ac.uk/prospero identifier is CRD42024498240.
结直肠癌是全球癌症相关死亡的第二大主要原因。尽管20%至55%的癌症患者使用质子泵抑制剂（PPI），但其对服用口服氟嘧啶卡培他滨的患者的影响仍不确定。我们研究了PPI如何影响卡培他滨治疗结直肠癌的有效性。
我们在PubMed、Embase和科学网数据库中搜索了研究PPI与卡培他滨联合使用与单独使用卡培他滨的研究。我们对所有终点使用随机效应模型。使用I统计量评估异质性。
我们纳入了676例接受卡培他滨单药治疗的患者。总体进展/无病生存有利于未使用PPI的患者（风险比2.1372；95%置信区间1.4591 - 3.1306；P < 0.001）。我们的结果表明，在结直肠癌患者中，使用PPI和卡培他滨的患者之间似乎没有差异（风险比1.5922；95%置信区间0.9718 - 2.6086；P = 0.065）。然而，经过敏感性调整分析后，PPI的使用与PPI使用呈负相关（风险比2.14；95%置信区间1.14 - 4.01；P < 0.001）。
接受口服化疗（特别是卡培他滨）的结直肠癌患者应监测PPI的使用情况。因此，在这些情况下的临床实践中应不鼓励使用PPI。
