A Meta-Analysis of the Impact of Proton Pump Inhibitors on Survival Outcomes in NSCLC Treated with Immunotherapy

Abstract

Background: It has recently been shown that concomitant medication, such as proton pump inhibitors (PPIs), can modulate the microbiome and has effect on the clinical outcome among advanced-stage cancer patients following immune checkpoint inhibitors (ICIs). Whether such relationship is associative or causative in advanced non-small cell lung cancer (NSCLC) is content of investigation. The current meta-analysis was conducted to explore the impact of proton pump inhibitors (PPIs) on ICIs treatment in NSCLC. Methods and Materials: The electronic databases were searched until September, 2022. Researches investigating the predictive role of PPIs in NSCLC following ICIs were included. Then, the meta-analysis was aim to reveal the influence of PPI use on survival efficacy. Results: 8 researches were finally included. For all interested outcomes, the between-study heterogeneity was low. Our results showed that the concomitant PPI use has a negative effect on the survival of NSCLC receiving ICIs. The pooled HRs of progression-free survival (PFS) and overall survival (OS) were HR = 1.33 (95% CI 1.21 to 1.46, p < 0.00001) and HR = 1.46 (95% CI 1.32 to 1.62, p < 0.00001) when compared to those without PPIs. Conclusion: The impact of PPI use is related to poor survival efficacy and may attenuate the anti-cancer activity of ICI. The underlying biological mechanisms of the relation between PPI and the efficacy of ICI treatment should be elucidate through further researches.