Interim Alimta due to concurrent PPI and TKI use - 1290278

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Interim Alimta due to concurrent PPI and TKI use - 1290278

Hi all. My mom was diagnosed with Stage IV NSCLC EGFR+ early in December. In January, she started Iressa and did fine on it for about a month. Then my mom started showing terrible stomach symptoms. At first we thought it was side effects from the Iressa but the symptoms got so bad that my mom was unable to eat. Blood tests showed elevated liver enzymes so the Iressa was stopped. Then we found out that my mom had esophageal thrush AND H. Pylori infections due to prolonged steroid use. My mom has been on quadruple therapy (Omeprazole, amoxicillin, clarithromycin, dyflucan) and has been getting much better but has been off of Iressa for almost a month. During this part of the treatment, my mom has to be on Omeprazole twice a day. My mom's onc says that Iressa won't work if my mom is taking a PPI twice a day. My mom's GI doctor said we could attempt to stop the PPI once the antibiotics are done but said that gastritis usually takes another 4-6 weeks to completely resolve. The GI doctor said that we could try decreasing the PPI to once a day or taking pepcid twice a day. My mom's onc is saying that if my mom needs to stay on the Omeprazole twice a day, she recommends my mom trying Alimta in the interim until her gastritis resolves.

I'm just looking for information about taking a TKI with omeprazole and what people's experience with Alimta (pemetrexed) is in terms of side effects. Any and all accounts and experiences would be helpful.

Hi samdig,

Hi samdig,

I'm sorry to hear your mom is having this problem. It's true that PPI can inhibit the efficacy of a EGFR TKI so it makes sense to stop it until the GI issue is resolved. In the meantime the options are to take chemo or wait without treatment. That's a determination only she and her oncologist can make. Alimta is possibly the best choice for a couple of reasons. It's side effect profile is probably less than most other chemo options. Even though this is anecdotal information it's a general agreement among oncologists and those being treated. There is also some evidence that those with a driver mutation have better efficacy with alimta than other chemo options. So alimta is usually the first go to chemo drug for people with adeno nsclc. Many have few or no side effects.

I hope your mom's GI issues are resolved soon and she does well moving forward.
All best,