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Do Proton Pump Inhibitors Influence Cabozantinib Outcomes in Metastatic Kidney Cancer?

By: Vanessa A. Carter, BS
Posted: Friday, April 9, 2021

Laurence Albiges, MD, PhD, of Institut Gustave Roussy, Villejuif, France, and colleagues explored the implications of proton pump inhibitors on the safety, efficacy, and residual concentration of the oral tyrosine kinase inhibitor cabozantinib in individuals with metastatic renal cell carcinoma. Published in The Oncologist, their data showed no significant impact of concomitant proton pump inhibitor usage on the safety or efficacy of cabozantinib, implying patients can remain on this treatment regimen during anticancer treatment.

This retrospective review focused on the data of 99 patients with metastatic renal cell carcinoma who were administered cabozantinib. Participant demographics such as prognostic factors, pathology, previous therapeutic strategies, lines of treatment, and proton pump inhibitor usage were obtained from the database. Additionally, a separate cohort of 50 individuals was formed for a pharmacokinetic study to analyze cabozantinib residual concentration.

The median follow-up was 30.3 months. In the first cohort, 43 patients were users of proton pump inhibitors. A majority (60.5%) of individuals were on them for a preexisting medical condition, whereas the others received them for management of cabozantinib-related adverse events.

The median time to treatment failure, progression-free survival, and overall survival were 12.7 months, 9.4 months, and 20.1 months, respectively. For users of proton pump inhibitors, the overall response and disease control rates were 33.4% and 95.2%, versus 38.2% and 89.1% for nonusers of these agents, respectively. Expressed as a proportion of days covered, therapeutic adherence in the pharmacokinetic study was 93.5%: 93.2% for users of proton pump inhibitors and 94.5% for nonusers of these agents.

Adverse events attributed to cabozantinib included diarrhea (61.6%), nausea (43.4%), loss of appetite (36.3%), dyspepsia (21.2%), mucositis (37.4%), vomiting (20.2%), increased liver function tests (44.4%), and weight loss (57.8%). Overall, the incidence was similar between the users and nonusers of proton pump inhibitors, and treatment discontinuation did not seem to differ between the two groups (72.1% vs. 73.3%, P = .587).

Disclosure: For full disclosures of the study authors, visit theoncologist.onlinelibrary.wiley.com.



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