Non-Small Cell Lung Cancer Coverage from Every Angle

Antibiotics and Proton Pump Inhibitors May Affect Outcomes in Patients Treated for Metastatic Lung Cancer

By: Cordi Craig
Posted: Tuesday, March 17, 2020

A retrospective, pooled analysis of the phase II POPLAR and phase III OAK trials suggested that antibiotics and proton pump inhibitors appear to be associated with poorer survival outcomes in patients with metastatic non–small cell lung cancer (NSCLC). Myriam Chalabi, MD, of the Netherlands Cancer Institute, Amsterdam, and colleagues noted that antibiotics and proton pump inhibitors may influence the efficacy of immune checkpoint inhibition and that the results warrant further investigation. The findings were published in Annals of Oncology.

The combined trial data included 1,512 patients with previously treated NSCLC. The patients were randomly assigned to receive atezolizumab (n = 757) or docetaxel (n = 755). In the atezolizumab group, 169 patients received antibiotics, and 234 received proton pump inhibitors. In the docetaxel group, 202 patients received antibiotics, and 260 patients received proton pump inhibitors.

Regardless of the treatment arm, antibiotics and proton pump inhibitors were both associated with shorter overall survival. Within the atezolizumab arm, overall survival was significantly shorter among patients who received antibiotics than those who did not (8.5 months vs. 14.1 months; P < .01). Similarly, the overall survival was significantly shorter for patients in the atezolizumab group who received proton pump inhibitors than for those who did not (9.6 months vs. 14.5 months; P = .0001). Progression-free survival was also significantly shorter among patients treated with proton pump inhibitors within the atezolizumab group (P = .001). Of note, no association between antibiotic or proton pump inhibitor use and survival rates within the docetaxel group was reported.

“Whether antibiotics and proton pump inhibitors are purely prognostic or contributing to resistance to checkpoint inhibition remains a matter of debate. However, these data should encourage physicians to carefully evaluate the need for co-medications such as proton pump inhibitors and antibiotics in their patients,” the research team concluded.

Disclosure: For full disclosures of the study authors, visit

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