Does gastric acid suppression affect sunitinib efficacy in patients with advanced or metastatic renal cell cancer?

J Oncol Pharm Pract. 2015 Jun;21(3):194-200. doi: 10.1177/1078155214527145. Epub 2014 Mar 24.


Introduction: Renal cell cancer is a chemotherapy-insensitive cancer treated by vascular endothelial growth factor receptor antagonists. Recently, a question has arisen on whether there is an interaction between tyrosine kinase inhibitors, such as sunitinib, and acid suppressing agents.

Methods: A retrospective chart review was conducted for patients at two tertiary care centers who received sunitinib between 1 January 2006 and 31 March 2013. Using electronic systems and a province-wide electronic health records database, medication dispensing records were obtained. A univariate Cox's proportional hazard model determined if acid suppression had effects on progression-free survival and overall survival.

Results: Of 383 patient charts reviewed, 231 were included in the study. Patients on intermittent acid suppression, lost to follow-up or received sunitinib for less than one week were excluded from the study. The median age of the study population was 65. Patients who received no acid suppression (n = 186) had a median progression-free survival of 23.6 weeks (95% CI, 19.0-31.9 weeks) and patients who received continuous acid suppression (n = 45) had a median progression-free survival of 18.9 weeks (95% CI, 11.0-23.7 p = 0.04). A median overall survival of 62.4 weeks (95% CI, 42.0-82.7 weeks) was observed in the group with no acid suppression, while a median overall survival of 40.9 weeks (95% CI, 26.1-74.4 weeks) was observed in the continuous acid suppression group (p = 0.02).

Conclusion: There was a significant difference in progression-free survival and overall survival between the acid suppressed and no acid suppression groups. Further research is required to confirm this potential interaction.

Keywords: Sunitinib; overall survival; progression-free survival; proton pump inhibitors; renal cell cancer.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antacids / adverse effects*
  • Carcinoma, Renal Cell / drug therapy*
  • Disease-Free Survival
  • Drug Interactions / physiology
  • Female
  • Gastric Acid / metabolism
  • Humans
  • Indoles / therapeutic use*
  • Kidney Neoplasms / drug therapy*
  • Male
  • Middle Aged
  • Pyrroles / therapeutic use*
  • Retrospective Studies
  • Sunitinib


  • Antacids
  • Indoles
  • Pyrroles
  • Sunitinib