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Does Treating Individuals for H pylori Infection Reduce Gastric Cancer Risk in Those With a Family History of the Disease?


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In a large Korean single-center study reported in The New England Journal of Medicine, Choi et al found that eradication of Helicobacter pylori infection was associated with a reduced risk of gastric cancer in individuals with a family history of gastric cancer in first-degree relatives.

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As stated by the investigators, H pylori infection and family history of gastric cancer are the main risk factors for gastric cancer.

Study Details

In the double-blind trial, performed at the National Cancer Center in Goyang, South Korea, 3,100 first-degree relatives of patients with gastric cancer were screened for H pylori infection between November 2004 and December 2011. A total of 1,676 participants with H pylori infection (modified intention-to-treat population) were randomly assigned to receive eradication therapy (n = 832) or placebo (n = 834).

Eradication therapy consisted of lansoprazole at 30 mg, amoxicillin at 1,000 mg, and clarithromycin at 500 mg each taken twice daily for 7 days. Surveillance endoscopies were performed every 2 years. The primary outcome measure was development of gastric cancer.

Key Findings

Median follow-up was 9.2 years. Gastric cancer developed in 10 participants (1.2%) in the treatment group vs 23 (2.7%) in the placebo group (hazard ratio [HR] = 0.45, 95% confidence interval [CI] = 0.21–0.94, P = .03).

Among the 10 participants in the treatment group who developed gastric cancer, 5 (50.0%) had persistent H pylori infection.

The number needed to treat to prevent one case of gastric cancer was 65.7 over the duration of the trial.

KEY POINTS

  • Gastric cancer developed in 10 participants (1.2%) in the treatment group vs 23 (2.7%) in the placebo group.
  • Among the 10 participants in the treatment group who developed gastric cancer, 5 (50.0%) had persistent H pylori infection.
  • Gastric cancer developed in 5 (0.8%) of the 608 participants with H pylori eradication and in 28 (2.9%) of the 979 with persistent infection.

H pylori eradication status was evaluated in 1,587 participants during follow-up, with eradication being confirmed in 551 (70.1%) of 786 participants in the treatment group and in 57 (7.1%) of 801 in the placebo group. H pylori infection persisted in the remaining 979 participants. Overall, gastric cancer developed in 5 (0.8%) of the 608 participants with eradication and in 28 (2.9%) of the 979 with persistent infection (HR = 0.27, 95% CI = 0.10–0.70).

Adverse events were mild, with those of any grade being more common in the treatment group (53.0% vs 19.1%, P < .001). Grade ≥ 3 adverse events occurred in seven patients (0.8%) in the treatment group. The most common adverse events of any grade in the treatment group included taste alteration (32% of patients in the treatment group, vs 4% of patients treated with placebo), diarrhea (22% vs 6%), nausea (7% vs 3%), and abdominal pain (5% vs 1%).

The investigators concluded: “Among persons with H pylori infection who had a family history of gastric cancer in first-degree relatives, H pylori eradication treatment reduced the risk of gastric cancer.”

Disclosure: The study was funded by the National Cancer Center, South Korea. For full disclosures of the study authors, visit nejm.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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