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Does gastric acid suppression affect sunitinib efficacy in patients with advanced or metastatic renal cell cancer?
Vincent H Ha1, Margaret Ngo2, Michael P Chu3
1Pharmacy Department, Cross Cancer Institute, Canada Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Canada.
Introduction:
Renal cell cancer is a chemotherapy-insensitive cancer treated by vascular endothelial growth factor receptor antagonists. Recently, a question has arisen on whether there is an interaction between tyrosine kinase inhibitors, such as sunitinib, and acid suppressing agents.
Methods:
A retrospective chart review was conducted for patients at two tertiary care centers who received sunitinib between 1 January 2006 and 31 March 2013. Using electronic systems and a province-wide electronic health records database, medication dispensing records were obtained. A univariate Cox's proportional hazard model determined if acid suppression had effects on progression-free survival and overall survival.
Results:
Of 383 patient charts reviewed, 231 were included in the study. Patients on intermittent acid suppression, lost to follow-up or received sunitinib for less than one week were excluded from the study. The median age of the study population was 65. Patients who received no acid suppression (n = 186) had a median progression-free survival of 23.6 weeks (95% CI, 19.0-31.9 weeks) and patients who received continuous acid suppression (n = 45) had a median progression-free survival of 18.9 weeks (95% CI, 11.0-23.7 p = 0.04). A median overall survival of 62.4 weeks (95% CI, 42.0-82.7 weeks) was observed in the group with no acid suppression, while a median overall survival of 40.9 weeks (95% CI, 26.1-74.4 weeks) was observed in the continuous acid suppression group (p = 0.02).
Conclusion:
There was a significant difference in progression-free survival and overall survival between the acid suppressed and no acid suppression groups. Further research is required to confirm this potential interaction.
Insights
Acid suppressing agents may negatively impact sunitinib efficacy in renal cell cancer patients. Continuous acid suppression was associated with significantly shorter progression-free and overall survival, warranting further investigation into this drug interaction.
Area of Science:
- Oncology
- Pharmacology
- Clinical Medicine
Background:
- Renal cell cancer (RCC) is a chemotherapy-resistant malignancy.
- Vascular endothelial growth factor receptor (VEGFR) antagonists, like sunitinib, are standard treatments for RCC.
- Potential interactions between VEGFR inhibitors and acid-suppressing agents require investigation.
Purpose of the Study:
- To investigate the potential interaction between sunitinib and acid-suppressing agents in renal cell cancer patients.
- To evaluate the effect of acid suppression on progression-free survival (PFS) and overall survival (OS) in patients treated with sunitinib.
Main Methods:
- Retrospective chart review of 231 patients treated with sunitinib at two tertiary care centers (2006-2013).
- Medication dispensing records were obtained via electronic systems and a provincial health records database.
- Univariate Cox's proportional hazard models assessed the impact of acid suppression on PFS and OS.
Main Results:
- Patients receiving continuous acid suppression (n=45) had significantly shorter median PFS (18.9 weeks) compared to those with no acid suppression (n=186, 23.6 weeks; p=0.04).
- Continuous acid suppression was also associated with significantly shorter median OS (40.9 weeks) versus no acid suppression (62.4 weeks; p=0.02).
- Exclusion criteria included intermittent acid suppression, loss to follow-up, or sunitinib treatment <1 week.
Conclusions:
- A significant difference in PFS and OS was observed between patients receiving acid suppression and those not.
- The findings suggest a potential negative interaction between acid-suppressing agents and sunitinib efficacy.
- Further research is necessary to confirm this interaction and its clinical implications.
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