尽管越来越多的数据表明质子泵抑制剂（PPI）会影响主要抗癌药物的疗效，但仍广泛用于癌症患者。这对于酪氨酸激酶抑制剂 (TKI) 和免疫检查点抑制剂 (CPI) 尤为重要。大多数 TKI 需要胃酸才能吸收，一些回顾性研究表明，联合处方会降低某些 TKI（厄洛替尼、吉非替尼和帕唑帕尼）使用的生存获益。微生物群、免疫系统和免疫疗法疗效之间的关系现已显而易见，就像众所周知使用 PPI 后肠道菌群的变化一样。许多回顾性文章，包括基于随机研究中个体参与者数据的文章，表明接受 CPI 治疗的患者在同时接受 PPI 治疗时，结果较差（总生存期、无进展生存期和缓解率），而 CPI 治疗没有影响这种联合处方是在未接受免疫疗法的对照组患者中进行的。在接受哌柏西利治疗的患者中也观察到了类似的数据。对于这些相互作用，使用预防原则并警告患者和医生这一点非常重要。对于因严重症状而需要抑酸的患者，建议使用抗酸剂或 H2 阻滞剂。版权所有 © 2024 Elsevier Ltd。保留所有权利。

Proton pump inhibitors (PPIs) are widely used in cancer patients despite accumulating data showing that they can impact the efficacy of major anticancer drugs. This is particularly important with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (CPIs).Most TKIs require gastric acidity for their absorption and some retrospective series demonstrated that coprescription decreases the survival benefit of some TKI use (erlotinib, gefitinib and pazopanib). Relations between microbiota, the immune system, and the efficacy of immunotherapy are now obvious, just as modifications to gut flora after PPIs use are well-known. Many retrospective articles, including articles based on individual-participant data from randomized studies, demonstrated that patients treated with CPIs have a poorer outcome (overall survival, progression-free survival and response rate) when they received PPIs concomitantly, while there was no impact of such coprescription among patients in control arms, not treated with immunotherapies. Similar data were also observed in patients treated with palbociclib.For these interactions, it is very important to use the precautionary principle and warn patients and physicians about this. In patients who require acid suppression because of severe symptoms, using antacids or H2 blockers could be recommended.Copyright © 2024 Elsevier Ltd. All rights reserved.