Concomitant use of antiacids in patients with advanced hepatocellular carcinoma (HCC) receiving sorafenib therapy


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Razwan Razak1,Victoria Kunene2,Yuk Ting Ma2
1University of Birmingham,2NHS Trust

Abstract

Background

There are reports suggesting that concomitant use of tyrosine kinase inhibitors (TKIs) and gastric acid suppression reduces overall survival. This single centre study is looking at the impact of acid suppression on survival in patients with inoperable hepatocellular carcinoma (HCC) receiving sorafenib therapy.

Method

Retrospective study of patients with inoperable HCC receiving sorafenib treated at Queen Elizabeth hospital Birmingham between January 2006 and April 2015. Data was collected from electronic patient archives. Primary objective was progression free survival (PFS) and secondary objective was overall survival (OS).

Results

One hundred and ninety seven (197) patients were identified and 182 patients were included in the analysis. 77 patients received concomitant acid suppression therapy with PPIs (omeprazole or lansoprazole) or ranitidine and 105 did not receive acid suppression.

Demographics:   Median age was 66 years (range 19-85 years). There were 149 males and 33 females. Child-Pugh scoring in no acid suppression group was:  A (31.3%), B (10.4%) C (0.5%) vs A (39.7%), B( 17.6%) and C (0.5%)in acid suppression group. Median PFS was 7.6 months (95% CI: 5.9-9.2 months),vs 1.9 months (95% CI: 1.4-2.3 months, p<0.0001) in favour of the no acid suppression group.  Median OS was 8.7 months (95% CI: 7.3-10.2 months) vs of 5.7 months (95% CI: 4.5-7.0 months) in favour of no acid suppression. (p<0.0001). Further analysis on patients with no acid suppression group with well-preserved liver functions showed a median OS of 10.9 months (95% CI: 7.2-14.6 months, p<0.0001).

Conclusion

Although this is a retrospective study with small numbers, the results show better disease control and survival in patients with no acid suppression group compared to continuous acid suppression group. Prospective multicentre studies are required to analyse the impact of antacids in patients receiving sorafenib.