In the Journals

Acid reflux medications may extend survival in HNSCC

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December 26, 2014

Two types of antacid medications commonly used by patients with head and neck squamous cell carcinoma to reduce acid reflux may provide a survival benefit, according to study results.

“While we had suspicions that these medications might have favorable secondary effects, our study suggests that they improve OS after treatment,” Silvana M. Papagerakis, MD, PhD, of the department of otolaryngology — head and neck surgery at the University of Michigan, said in a press release.

Gastroesophageal reflux may play a role in the etiology of head and neck squamous cell carcinoma (HNSCC). It also may contribute to complications after surgery or during radiotherapy, according to background information provided in the study.

Patients with HNSCC often use antacid medications, but the association between those agents and outcomes is not clear.

In the current study, Papagerakis and colleagues assessed the relationship between two antacid medications — histamine receptor-2 antagonists (H2RA) and proton pump inhibitors — and treatment outcomes in 596 patients with previously untreated HNSCC.

In the cohort, 191 patients used only proton pump inhibitors after diagnosis, whereas 83 used only H2RAs and 136 used both.

Median follow-up was 55 months (range, 50-60).

All patients enrolled in the university’s SPORE epidemiology program between January 2003 and November 2008.

Papagerakis and colleagues performed an analysis that accounted for several variables, including age, demographics, tumor stage, primary site, HPV16 status, smoking status and treatment modality.

Results showed patients who used proton pump inhibitors demonstrated a 45% reduced risk for death compared with those who did not. Patients who used HR2As demonstrated a 33% reduced risk for death compared with those who did not. Results showed use of proton pump inhibitors alone (P<.001), use of H2RAs alone (P=.0479) and use of both agents (P=.0133) were associated with significantly longer OS.

Multivariable Cox models that adjusted for prognostic covariates showed use of both proton pump inhibitors and H2RAs were significant prognostic factors for OS. Use of H2RAs also was a significant prognostic factor for RFS in patients with HPV16-positive patients.

Researchers reported a statistically significant association between OS and the proton pump inhibitors omeprazole (P=.0008) and esomeprazole (P=.001). They observed a trend toward improved OS with lansoprazole (P=.06); however, they observed no association between OS and pantoprazole (P=0.67).

The association between HR2As and OS was significant when all types were considered together (P=.0479), but not when each type was considered individually.

“The findings in this large cohort study indicate that routine use of antacid medications may have significant therapeutic benefit in patients with HNSCC,” Papagerakis and colleagues concluded. “The reasons for this association remain an active area of investigation and could lead to identification of new treatment and prevention approaches with agents that have minimal toxicities.”

Disclosure: The researchers report consultant/advisory roles with IRX Therapeutics.

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