With family history of gastric cancer, H pylori treatment matters

  • Choi IJ & al.
  • N Engl J Med
  • 30 Jan 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Treatment of Helicobacter pylori infection leads to fewer cases of gastric cancer among participants with a first-degree relative diagnosed with gastric cancer.

Why this matters

  • Due to a lack of evidence, there is disagreement among guidelines and consensus reports as to whether test and treat H pylori among individuals with a first-degree relative history of gastric cancer.

Study design

  • 1838 individuals with a first-degree relative diagnosed with gastric cancer and who had H pylori infections were randomized to H pylori eradication (lansoprazole, amoxicillin, and clarithromycin) or placebo.
  • Funding: National Cancer Center, South Korea.

Key results

  • Median follow-up, 9.2 years.
  • 1.2% of the treatment group developed gastric cancer, compared with 2.7% of placebo (HR, 0.45; P=.03).
  • Intention-to-treat analysis showed treatment led to fewer cases of gastric cancer: HR, 0.42 (95% CI, 0.20-0.89).
  • Number needed to treat to prevent one gastric cancer, 65.7 (95% CI, 35.1-503.8).
  • Gastric cancer incidence was lower in participants with eradicated infection (0.94 vs 3.41 cases per 1000 person-years).
  • There was no significant difference in OS between the 2 groups, and no deaths from gastric cancer in either group.

Limitations

  • Single-center study.