A systematic review and meta-analysis of users versus non-users: unveiling the influence of proton pump inhibitors on capecitabine efficacy in colorectal cancer.
Francisco Cezar Aquino de Moraes, Estella Aparecida de Laia, Vitor Kendi Tsuchiya Sano, Aline Gabriele Etur Dos Santos, Caroline R M Pereira, Rommel Mario Rodríguez Burbano
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引用次数: 0
Abstract
Introduction: 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.
Methods: 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 I2 statistics.
Results: 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; p < 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; p = 0.065). However, after sensitivity-adjusted analysis, PPI use was negatively associated with PPI use (HR 2.14; 95% CI 1.14-4.01; p < 0.001).
Conclusion: 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.
Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42024498240.
导言：结直肠癌是全球癌症相关死亡的第二大原因。尽管有 20% 至 55% 的癌症患者使用质子泵抑制剂 (PPI)，但质子泵抑制剂对服用卡培他滨这种口服氟嘧啶类药物的患者的影响仍不确定。我们研究了质子泵抑制剂如何影响卡培他滨治疗结直肠癌的效果：我们在 PubMed、Embase 和 Web of Science 数据库中检索了调查 PPI 与卡培他滨同时使用和单独使用卡培他滨的研究。所有终点均采用随机效应模型。使用I2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。未使用PPI的患者总体进展/无病生存率更高（HR 2.1372; 95% CI 1.4591-3.1306; p p = 0.065）。然而，经过敏感性调整分析后，PPI 使用与 PPI 使用呈负相关（HR 2.14；95% CI 1.14-4.01；P 结论：PPI 使用与 PPI 使用呈负相关（HR 2.1372；95% CI 1.4591-3.1306；P = 0.065）：接受口服化疗（尤其是卡培他滨化疗）的结直肠癌患者应监测PPIs的使用情况。因此，在临床实践中应避免在这些病例中使用PPIs。协议注册：www.crd.york.ac.uk/prospero 识别码为CRD42024498240。
期刊介绍：
Advances in drug development technologies are yielding innovative new therapies, from potentially lifesaving medicines to lifestyle products. In recent years, however, the cost of developing new drugs has soared, and concerns over drug resistance and pharmacoeconomics have come to the fore. Adverse reactions experienced at the clinical trial level serve as a constant reminder of the importance of rigorous safety and toxicity testing. Furthermore the advent of pharmacogenomics and ‘individualized’ approaches to therapy will demand a fresh approach to drug evaluation and healthcare delivery.
Clinical Pharmacology provides an essential role in integrating the expertise of all of the specialists and players who are active in meeting such challenges in modern biomedical practice.
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