Al's Comment:

 This may affect you -  so read this!   Brain tumor patients are usually given a drug to help prevent stomach problems from the steroids they use. Most commonly it is a proton pump inhibitor such as 

  • Omeprazole (Prilosec)
  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)
  • Rabeprazole (AcipHex)
  • Pantoprazole (Protonix)
  • Dexlansoprazole (Dexilant)
  • Zegerid (omeprazole with sodium bicarbonate), 

This letter to the editor to Neuro-Oncology practice raises a very serious issue.  These drugs may cause resistance to Temodar (Temozolomide) by increasing the levels of an enzyme called ALDH1A1.  If this enzyme is high, the average survival for a patient with a methylated MGMT GBM is 14.6 months compared to 32.9 months if the enzyme is low.  For Unmethylated MGMT, the  numbers are 12.6 vs 21.4 months.  This is a HUGE difference.

This has not been tested in a GBM trial, but it raises a red flag when considering these drugs, especially when there are easy alternatives. Instead of the drugs listed above,  H3 blockers, such as 

  • cimetidine (Tagamet)
  • ranitidine (Zantac)
  • nizatidine (Axid)
  • famotidine (Pepsid)
can be used instead.   If you are using one of the drugs,  print the article out and show it to your doctor and ask if you can try these alternatives while further study is underway!


Posted on: 06/15/2022

Unintended effects of proton pump inhibitors (PPIs) in patients with glioblastoma (GBM): A double-edged sword 


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