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Does Proton Pump Inhibitors Decrease the Efficacy of Palbociclib and Ribociclib in Patients with Metastatic Breast

Hatice Odabas1, Akif Dogan1, Melike Ozcelik2

  • 1Department of Medical Oncology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul 34865, Turkey.

Medicina (Kaunas, Lithuania)
|March 29, 2023
PubMed
Summary

Concurrent use of proton pump inhibitors (PPIs) with palbociclib or ribociclib did not significantly impact progression-free survival (PFS) in metastatic breast cancer patients. These findings suggest PPIs can be safely co-administered with these CDK4/6 inhibitors when clinically indicated.

Keywords:
drug-drug interactionsmetastatic breast cancerpalbociclibproton pump inhibitorsribociclib

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Area of Science:

  • Oncology
  • Pharmacology
  • Breast Cancer Therapeutics

Background:

  • Hormone receptor-positive (HR+), HER2-negative metastatic breast cancer (mBC) is often treated with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors like palbociclib and ribociclib.
  • Proton pump inhibitors (PPIs) are frequently prescribed for gastrointestinal issues, raising questions about potential drug interactions with cancer therapies.
  • The impact of concurrent PPI use on treatment efficacy, specifically progression-free survival (PFS), in patients receiving CDK4/6 inhibitors remains an area of clinical interest.

Purpose of the Study:

  • To evaluate the effect of concurrent proton pump inhibitor (PPI) use on progression-free survival (PFS) in patients with HR+, HER2-negative metastatic breast cancer.
  • To compare PFS outcomes for patients treated with palbociclib or ribociclib, stratified by concurrent PPI usage.
  • To determine if PPIs have a detrimental effect on the efficacy of CDK4/6 inhibitors in this patient population.

Main Methods:

  • Retrospective analysis of 220 patients with HR+, HER2- mBC treated with palbociclib or ribociclib.
  • Patients were categorized into 'concurrent PPIs' (PPI use for ≥2/3 of therapy) and 'no concurrent PPIs' groups.
  • Progression-free survival (PFS) was compared between these groups for both palbociclib and ribociclib treatment arms.

Main Results:

  • Among 120 patients on palbociclib, PFS was 14.4 months with PPIs (n=57) versus 15.8 months without PPIs (n=63), showing no significant difference (p=0.82).
  • Among 100 patients on ribociclib, PFS was 22.4 months with PPIs (n=29) versus 20.2 months without PPIs (n=71), also showing no significant difference (p=0.40).
  • No statistically significant impact of concurrent PPI use on PFS was observed for either palbociclib or ribociclib.

Conclusions:

  • Concurrent use of common PPIs (lansoprazole, pantoprazole, esomeprazole) with palbociclib or ribociclib does not appear to negatively affect progression-free survival.
  • PPIs can likely be used concurrently with palbociclib and ribociclib in mBC patients when clinically necessary.
  • Further investigation into the interaction between PPIs and CDK4/6 inhibitors is warranted.