A new study published in JAMA Oncology, which explores whether proton pump inhibitors impair the activity of capecitabine in metastatic gastroesophageal cancer (GEC) patients, may raise caution among some oncologists. The study informs oncologists treating patients with capecitabine that there could be negative interaction with gastric acid suppressants such as PPIs and also possibly histamine antagonists. The secondary analysis of TRIO-013 was a phase III randomized trial of capecitabine and oxaliplatin with or without lapatnib in meatstatic GEC patients receiving CapeOx. PPIs significantly and negatively affected survival and disease control rates. PPIs negative impact on capecitabine efficacy could result from altered dissolution and absorption caused by increased gastric pH levels. Please see the published study for greater detail.