Značilnosti zdravljenja z zaviralci protonske črpalke pri bolnikih s pljučnim rakom zdravljenih z imunoterapijo na Kliniki Golnik

Možek, Tjaša (author), Knez, Lea (mentor), Jazbar, Janja (comentor)

Nedrobnocelični pljučni rak (NDRP) je pogost rak z visoko umrljivostjo. Imunoterapija z zaviralci imunskih kontrolnih točk (ZIKT) je ključna pri zdravljenju, vendar se učinkovitost ZIKT med bolniki razlikuje. Med dejavniki, ki lahko vplivajo na učinkovitost ZIKT, je tudi uporaba zaviralcev protonske črpalke (ZPČ). Namen raziskave je bil preučiti vzorce predpisovanja ZPČ pri bolnikih z napredovalim NDRP, ki so se zdravili z ZIKT na Kliniki Golnik, in oceniti sodelovanje pri zdravljenju z ZPČ v času zdravljenja z ZIKT ter trajanje zdravljenja z ZPČ. V retrospektivno opazovalno raziskavo smo vključili bolnike z NDRP, zdravljene z ZIKT na Kliniki Golnik od vključno julija 2015 do vključno decembra 2021. Podatke smo analizirali s pomočjo programov Excel, SPSS in programskega jezika R, ki vključuje paket AdhereR. Prevzeme ZPČ smo zapisali znotraj opazovalnega okna, od 30 dni pred uvedbo ZIKT do zadnjega odmerka ZIKT. Bolnike smo razdelili na bolnike brez ZPČ, bolnike, ki so imeli ZPČ predpisan že v obdobju od 30 dni pred do 30 dni po uvedbi ZIKT (ZPČ ⡤ 30), in bolnike z ZPČ predpisanim po 31. dnevu po uvedbi ZIKT (ZPČ ⡥ 31). Sodelovanje pri zdravljenju z ZPČ smo ovrednotili s pomočjo deleža pokritih dni (ang. proportion of days covered, PDC), trajanje pa z metodo Kaplan-Meier. Med 290 bolniki jih je le 28,0 % bilo brez ZPČ (n = 81), 55,5 % bolnikov je bilo v skupini ZPČ ⡤ 30 (n = 161) in 16,5 % v skupini ZPČ ⡥ 31 (n = 48). Večina bolnikov v skupinah ZPČ ⡤ 30 in ZPČ ⡥ 31 (72,7 % in 79,2 %) je zdravljenje začela s pantoprazolom, večina (53,4 % bolnikov z ZPČ ⡤ 30 in 66,7 % bolnikov z ZPČ ⡥ 31) z dvakratnim odmerkom glede na primerljive odmerke v terapevtski skupini ZPČ. Bolniki so imeli zalogo ZPČ, prikazano s PDC, v povprečju 70,5 % opazovalnega okna za bolnike z ZPČ ⡤ 30 in 31,9 % opazovalnega okna za bolnike z ZPČ ⡥ 31, mediana trajanja zdravljenja z ZPČ pa je bila 119 dni (ZPČ ⡤ 30) in 60 dni (ZPČ ⡥ 31). Manjšina bolnikov v skupinah ZPČ ⡤ 30 in ZPČ ⡥ 31 se je zdravila kratkotrajno, do 60 dni (31,1 % med bolniki z ZPČ ⡤ 30 in 41,7 % med bolniki z ZPČ ⡥ 31). Naša raziskava je pokazala, da bolniki z NDRP, ki prejemajo ZIKT, zelo pogosto in za daljša obdobja uporabljajo ZPČ.

• Language: Slovenian
• Keywords: nedrobnocelični pljučni rak, imunoterapija, zaviralci protonske črpalke, AdhereR
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2024
• PID: 20.500.12556/RUL-158515
• Publication date in RUL: 14.06.2024

Secondary language

• Language: English
• Title: Characteristics of treatment with proton pump inhibitors among lung cancer patients treated with immunotherapy at the University Clinic Golnik

Abstract

Non-small cell lung cancer (NSCLC) is a common cancer with high mortality. Immunotherapy with immune checkpoint inhibitors (ICIs) has an important role in its treatment, but its effectiveness varies from patient to patient. Factors that influence the effectiveness of ICI include the use of proton pump inhibitors (PPIs). The aim of the study was to investigate PPI prescribing patterns in patients with advanced NSCLC treated with ICIs at the University Clinic Golnik and evaluate PPI treatment adherence during ICI therapy and the duration of PPI treatment. We conducted a retrospective observational study that included NSCLC patients treated with ICIs at the University Clinic Golnik from July 2015 to December 2021. Data were analyzed using Excel, SPSS, and the R programming language, including the AdhereR package. PPI prescriptions were recorded within the observation window, i.e., from 30 days before the start of ICI treatment until the last ICI dose. Patients were divided into as those with no PPIs, those with PPIs prescribed within 30 days before or after ICI initiation (PPI ⡤ 30), and those with PPIs prescribed after day 31 post-ICI initiation (PPI ⡥ 31). Adherence was assessed by the proportion of days covered (PDC), and duration was assessed using the Kaplan-Meier method. Off the 290 patients, only 27.9 % were without PPIs (n = 81), 55.5 % were in the PPI ⡤ 30 group (n = 161), and 16.6 % were in the PPI ⡥ 31 group (n = 48). The majority of patients in both the PPI ⡤ 30 and PPI ⡥ 31 groups (72.7 % and 79.2 %, respectively) started treatment with pantoprazole, with most (53.4 % in the PPI ⡤ 30 and 66.7 % in the PPI ⡥ 31 group) receiving a double dose according to comparable doses in the PPI therapeutic group. Patients had access to PPIs, as indicated by PDC, on average 70.5 % and 31.9 % of the observation window for PPI ⡤ 30 and PPI ⡥ 31 patients, respectively, with a median duration of PPI treatment of 119 days and 60 days, respectively. A minority of patients in both the PPI ⡤ 30 and PPI ⡥ 31 groups received short-term treatment of up to 60 days (31.1 % in PPI ⡤ 30 patients and 41.7 % in PPI ⡥ 31 patients). Our study found that NSCLC patients receiving ICIs were prescribed PPIs frequently and for longer periods of time.

• Keywords: non-small cell lung cancer, immunotherapy, proton pump inhibitors, program AdhereR