Zhang JL, Liu M, Yang Q, Lin SY, Shan HB, Wang HY, Xu GL. Effects of omeprazole in improving concurrent chemoradiotherapy efficacy in rectal cancer. World J Gastroenterol 2017; 23(14): 2575-2584 [PMID: 28465642 DOI: 10.3748/wjg.v23.i14.2575]
Corresponding Author of This Article
Guo-Liang Xu, Professor, Department of Endoscopy and Laser, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, East Building, Guangzhou 510060, Guangdong Province, China. xugl@sysucc.org.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jin-Liang Zhang, Department of Medical Oncology, Guangdong Medical University Affiliated Longhua Central Hospital, Shenzhen 518110, Guangdong Province, China
Min Liu, Department of Internal Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518110, Guangdong Province, China
Qing Yang, Shi-Yong Lin, Hong-Bo Shan, Guo-Liang Xu, Department of Endoscopy and Laser, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Hui-Yun Wang, Department of Experimental Research, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Author contributions: Zhang JL and Liu M contributed equally to this work; Wang HY and Xu GL designed the research; Zhang JL, Liu M, Yang Q, Lin SY and Shan HB collected data; Zhang JL and Liu M analyzed data; Zhang JL and Liu M drafted the manuscript; Wang HY critically revised the manuscript for important intellectual content; Xu GL supervised the study; all authors have read and approved the final version of the manuscript.
Institutional review board statement: The IRB of SYSUCC has approved the protocol of this study.
Informed consent statement: All study participants or their legal guardian provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guo-Liang Xu, Professor, Department of Endoscopy and Laser, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, East Building, Guangzhou 510060, Guangdong Province, China. xugl@sysucc.org.cn
Telephone: +86-20-87343224 Fax: +86-20-87343224
Received: December 9, 2016 Peer-review started: December 11, 2016 First decision: December 29, 2016 Revised: January 26, 2017 Accepted: February 16, 2017 Article in press: February 16, 2017 Published online: April 14, 2017 Processing time: 125 Days and 21 Hours
Abstract
AIM
To explore the effects of omeprazole on chemoradiotherapy efficacy and tumor recurrence in rectal cancer.
METHODS
The medical data of 125 rectal cancer patients who received the same neoadjuvant chemoradiotherapy (CRT) followed by surgery were retrospectively collected. Patients who received omeprazole (OME) orally at a dose of 20 mg at least once daily for six days and/or intravenously at 40 mg a day were recognized as eligible OME users (EOU). Otherwise, patients were regarded as non-eligible OME users (non-EOU). Moreover, a preferred OME dose cut-off of 200 mg on tumor recurrence was obtained by receiver operating characteristic (ROC) curves. Patients were divided into two groups: the effective OME group (EOG, OME ≥ 200 mg) and the non-effective OME group (non-EOG, OME < 200 mg).
RESULTS
The good response rate of CRT efficacy (50.8%) in EOU was significantly increased compared with non-EOU (30.6%) (P = 0.02). The recurrence rate in the EOG was 10.3%, which was significantly lower compared with 31.3% in non-EOG (P = 0.025). The good response rate of CRT efficacy in EOG was 55.2%, which was obviously higher compared with 36.5% in non-EOG, with a significant difference (P = 0.072). Multivariate Cox analysis demonstrated that OME (non-EOG and EOG) was an independent and significant impact factor for DFS (P = 0.048, HR = 0.30, 95%CI: 0.09-0.99).
CONCLUSION
When applied as an adjuvant drug in cancer treatment for relieving common side effects of chemotherapy, omeprazole has a synergetic effect in improving CRT efficacy and decreasing rectal cancer recurrence.
Core tip: In in vitro and in vivo studies, proton pump inhibitors (PPIs) induce apoptosis of gastric cancer cells, B-cell tumors and hepatoblastoma cells and promote autophagy in melanoma cells and pancreatic cancer cells. PPIs also sensitize chemo-resistant tumors to cytotoxic drugs and improve the efficacy of T-cell-based cancer immunotherapy. However, whether PPIs affect chemoradiotherapy (CRT) efficacy, decrease tumor recurrence and improve survival in rectal cancer patients remains unclear. In the present study, when used as adjuvant drug in cancer treatment, omeprazole has a synergetic effect in improving CRT efficacy and decreasing recurrences in rectal cancer.
