JAMA Oncology ( IF 28.4 ) Pub Date : 2018-02-01 , DOI: 10.1001/jamaoncol.2017.3407 Guo-Fu Li 1 , Guo Yu 2 , Yan Gong 2
To the Editor Based on a secondary analysis of the TRIO-013/LOGiC trial, Chu and colleagues1 recently reported an association between concomitant use of proton pump inhibitors (PPIs) and capecitabine efficacy in patients with advanced gastroesophageal cancer. In patients with gastroesophageal cancer receiving capecitabine and oxaliplatin, PPI users had significantly poorer median progression-free survival, 4.2 vs 5.7 months (hazard ratio, 1.55; 95% CI, 1.29-1.81; P < .001); median overall survival, 9.2 vs 11.3 months (hazard ratio, 1.34; 95% CI, 1.06-1.62; P = .04), and disease control rate (71.2% vs 82.5%; P = .02) vs PPI nonusers.1 The PPI users were defined as patients whose PPI prescription overlapped with capecitabine plus oxaliplatin treatment duration by at least 20% of the time.1 However, the authors did not provide any information about the definition of the PPI nonusers, which warrants further consideration. The PPI nonusers may be defined either as patients whose PPI prescription overlapped with capecitabine plus oxaliplatin treatment duration by less than 20% of the time or as patients who did not take PPI at baseline and during the trial, like the previous analyses.2,3 If the first definition was used, a proportion of patients who took PPI at baseline and during the trial with a duration less than 20% of study time would be identified as the PPI nonusers, which is irrational and inappropriate. As such, the effect of concomitant use of PPIs on the anticancer efficacy of capecitabine may have been underestimated.
中文翻译:
影响质子泵抑制剂与卡培他滨在晚期胃食管癌中疗效关联的因素
致编辑根据对 TRIO-013/LOGiC 试验的二次分析,Chu 及其同事1最近报告了在晚期胃食管癌患者中同时使用质子泵抑制剂 (PPI) 与卡培他滨疗效之间的关联。在接受卡培他滨和奥沙利铂治疗的胃食管癌患者中,使用 PPI 的中位无进展生存期明显较差,分别为 4.2 个月和 5.7 个月(风险比,1.55;95% CI,1.29-1.81;P < .001);中位总生存期,9.2 vs 11.3 个月(风险比,1.34;95% CI,1.06-1.62;P = .04)和疾病控制率(71.2% vs 82.5%;P = .02)vs PPI 非使用者。1PPI 使用者定义为 PPI 处方与卡培他滨加奥沙利铂治疗持续时间重叠至少 20% 的患者。1然而,作者没有提供任何关于 PPI 非用户定义的信息,这值得进一步考虑。不使用 PPI 的患者可以定义为 PPI 处方与卡培他滨加奥沙利铂治疗时间重叠少于 20% 的患者,或者像之前的分析一样在基线和试验期间未服用 PPI 的患者。2 ,3如果使用第一个定义,在基线和试验期间服用 PPI 且持续时间少于研究时间 20% 的患者将被确定为不使用 PPI 的患者,这是不合理和不恰当的。因此,同时使用 PPI 对卡培他滨抗癌疗效的影响可能被低估了。