Lansoprazole with Atezolizumab Interaction Details

Brand Names Associated with Lansoprazole

Brand Names Associated with Atezolizumab

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 17, 2023

Interaction Effect

Impaired efficacy of atezolizumab

Interaction Summary

Proton pump inhibitors (PPIs) administered prior to and during atezolizumab therapy may decrease the effectiveness of atezolizumab. In a post-hoc analysis of pooled data from 5 pivotal trials in patients with NSCLC, the use of a PPI was associated with a significant decrease in the magnitude of the OS and PFS benefit of atezolizumab compared with PPI non-use. Evaluate the clinical need for use of a PPI and consider discontinuation prior to initiation of atezolizumab if possible.

Severity

Major

Onset

Unspecified

Evidence

Established

How To Manage Interaction

Proton pump inhibitors (PPIs) administered prior to and during atezolizumab therapy may decrease the effectiveness of atezolizumab, leading to reduced overall survival and progression-free survival benefit. Evaluate the clinical need for use of a PPI and consider discontinuation prior to initiation of atezolizumab if possible.

Mechanism Of Interaction

Decrease in gut bacteria diversity by proton pump inhibitors

Literature Reports

A) In a post-hoc analysis of pooled data from 5 pivotal trials (IMpower130, IMpower131, IMpower150, OAK, and POPLAR) in patients with NSCLC (N=4458), the use of a PPI (any use documented as continuing during treatment; n=1225; omeprazole, n=559; pantoprazole, n=391; esomeprazole, n=136; lansoprazole, n=104; rabeprazole, n=27; dexlansoprazole, n=5; vanoprazan, n=3) was associated with a significant decrease in the magnitude of atezolizumab overall survival (OS) benefit (as assessed by HR of atezolizumab vs comparator arms) compared with PPI non-use (HR 1; 95% CI, 0.85 to 1.17 vs HR, 0.76; 95% CI, 0.69 to 0.83). The use of a PPI also demonstrated a significant decrease in the magnitude of progression-free survival (PFS) benefit with atezolizumab (HR 0.93; 95% CI, 0.76 to 1.13 vs HR, 0.75; 95% CI, 0.65 to 0.88). Consistent findings were observed across trials; indicating a decrease in atezolizumab OS benefit when being used as both first-line chemoimmunotherapy and later line monotherapy. In patients randomized to atezolizumab (n=2723), PPI use was associated with significantly worse OS (adjusted HR, 1.23; 95% CI, 1.09 to 1.37) and PFS (adjusted HR, 1.15; 95% CI, 1.03 to 1.28) compared with PPI non-use. In the comparator arms randomized to therapy without atezolizumab (n=1735), no significant association between PPI use and altered OS or PFS was observed .

Lansoprazole Overview

• Prescription lansoprazole is used to treat the symptoms of gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach) in adults and children 1 year of age and older. Prescription lansoprazole is used to treat the damage from GERD in adults and children 1 year of age and older. Prescription lansoprazole is used to allow the esophagus to heal and prevent further damage to the esophagus in adults with GERD. Prescription lansoprazole is also used to treat ulcers (sores in the lining of the stomach or intestine), to prevent more ulcers from developing in adults whose ulcers have already healed, and to decrease the risk that adults who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) will develop ulcers. Prescription lansoprazole is also used to treat conditions where the stomach produces too much acid, such as Zollinger-Ellison syndrome in adults. Prescription lansoprazole is also used in combination with other medications to treat and prevent stomach ulcers caused by a certain type of bacteria (H. pylori) in adults. Nonprescription (over-the-counter) lansoprazole is used to treat frequent heartburn (heartburn that occurs two or more days per week) in adults. Lansoprazole is in a class of medications called proton pump inhibitors. It works by decreasing the amount of acid made in the stomach.

Atezolizumab Overview

• Atezolizumab injection is used alone or with other chemotherapy medications to treat certain types of non-small cell lung cancer (NSCLC) in adults. Atezolizumab injection is also used in combination with other chemotherapy medications to treat certain types of small cell lung cancer (SCLC), hepatocellular carcinoma (HCC), and melanoma (a type of skin cancer) in adults. Atezolizumab is also used alone to treat certain types of alveolar soft tissue sarcomas (cancer that forms in muscles, fat, or nerves) in adults and children 2 years of age or older. Atezolizumab injection is in a class of medications called monoclonal antibodies. It works by blocking the action of a certain protein in cancer cells. This helps the person's immune system to fight against the cancer cells, and helps to slow tumor growth.

• Your doctor will review your specific type of cancer and past treatment history and other available treatments to determine if atezolizumab injection is right for you.

Return To Our Drug Interaction Homepage

Feedback, Question Or Comment About This Information?

Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.