A patient just thought of calming his stomach burns. His doctor discovers that the medication used, an PPI, interfered with his treatment against cancer. This case, far from isolated, reveals a worrying drug interaction. Professor Jean-Luc Raoul, oncologist, is sounding the alarm.
THE cancer treatments have experienced major advances in recent years, notably thanks to immunotherapy and targeted therapies. However, an interaction that is still too little known could reduce its effectiveness. This is particularly the case between the inhibitors of the proton pump (PPI), prescribed to relieve digestive disorders, and certain anti -cancer drugs. Professor Jean-Luc Raoul, oncologist in Saint-Herblain, alerts to this phenomenon in a study published in 2024. He reveals that a quarter of patients under anti-cancer treatment take simultaneously IPPwith potentially serious consequences on their survival.
Drugs incompatible with anticancer treatment
Very widespread, but poorly monitored drugs
THE Proton pump inhibitors (IPP), such as omeprazole, esomeprazole or Lansoprazole, are among the most prescribed drugs in France, with more than 16 million prescriptions in 2019. Their effectiveness against stomach burns, ulcers and gastroesophageal reflux in fact frequent allies, including patients with patients cancer. However, their use is often extended without reassessment and their potential impact on oncological treatments remains largely underestimated. According to Professor Jean-Luc Raoul, these prescriptions, sometimes initiated by the oncologists themselves to relieve digestive side effects, can interfere with the effectiveness of anticancer therapies, reports Feminine.
Disturbed absorption of targeted treatments
PPI act by reducing gastric acidity, which changes the pH of the stomach. However, some anticancer treatmentsin particular inhibitors of tyrosine kinase (ITK) such as erlotinib, gefitinib or pazopanib, require an acid environment to be properly absorbed. By neutralizing this acidity, the PPIs decrease the bioavailability of these molecules, reducing their concentration in the blood and therefore their therapeutic efficiency. This interaction can compromise the chances of remission, or even lead to a failure of treatment.
An impact on microbiota and immunotherapy
Beyond absorption, the IPP disturbs theIntestinal microbiota balancecentral element of the immune system, reveals Ouest-France. However, the effectiveness of immunotherapy is based on a robust and well -regulated immune response. Several studies have shown that patients under IPP before or during a immunotherapy have a reduced overall survival and a lower response rate. This alteration of the microbiota can harm the action of immune control points inhibitors, such as nivolumab or pembrolizumab.
Adapt the prescriptions to protect patients
Should I stop PPIs?
The stop of proton pump inhibitors (PPI) should not be systematic, but envisaged with discernment. Professor Jean-Luc Raoul insists on an individualized reassessment, taking into account the type of anticancer treatment and the digestive state of the patient. A national retrospective study is underway to better understand the real impact of these interactions, but its results will only be available in several years. In the meantime, each patient under oncological treatment should discuss with their doctor the relevance of their anti-acid treatment, in order to avoid any potential interference with anti-cancer therapies.
What alternatives to consider?
For patients with reflux or stomach burnsIPP alternatives exist and can be envisaged without compromising the effectiveness of anti -cancer treatments. Classic antacids, such as Gaviscon, offer rapid and punctual relief without changing gastric pH in a prolonged way. H2 receptor antagonists, such as Ranitidine or Famotidine, are also recommended. Admittedly, they act more slowly, but they have a much lower risk of interaction with targeted therapies or immunotherapy. These options must be adapted to the patient’s profile, favoring the least invasive and most compatible forms with the Oncological protocol.
Inform patients to better protect them
Prevention comes above all through information. Too many patients are unaware that their digestive treatment can compromise the effectiveness of their anticancer protocol. Reinforced coordination between oncologists, general practitioners and pharmacists is essential to avoid prolonged or inappropriate prescriptions. Furthermore, the healthcare professionals must raise awareness of patients with the risks of interaction, while offering them safe alternatives.