J Cancer 2013; 4(7):549-556. doi:10.7150/jca.6888
Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes
1. Division of Cancer Medicine,
2. Department of Breast Medical Oncology,
3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
BACKGROUND: ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may have anti-tumor properties. We investigated whether the use of ACEI/ARBs affects the clinical outcomes of primary breast cancer patients receiving taxane and anthracycline-based neoadjuvant chemotherapy.
METHODS: We included 1449 patients with diagnosis of invasive primary breast cancer diagnosed at the MD Anderson Cancer Center between 1995 and 2007 who underwent neoadjuvant chemotherapy. Of them, 160 (11%) patients were identified by review of their medical record, as ACEI/ARBs users. We compared pathologic complete response (pCR) rates, relapse-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) between ACEI/ARB users and non-users. Descriptive statistics and Cox proportional hazards model were used in the analyses.
RESULTS: There was no difference in the pCR rates between ACEI/ARB users and non-users (16% vs 18.1%, p-=0.50). After adjustment for important demographic and clinical characteristics, no significant differences between ACEI/ARB users and nonusers were observed in RFS (HR=0.81; 95% CI=0.54-1.21), DSS (HR=0.83; 95% CI=0.52-1.31), or OS (HR=0.91; 95% CI =0.61-1.37). In a subgroup analysis, the 5-year RFS was 82% in ARB only users versus 71% in ACEI/ARB non-users (P=0.03). In the multivariable analysis, ARB use was also associated with a decreased risk of recurrence (HR=0.35; 95% CI=0.14-0.86). No statistically significant differences in DSS or OS were seen.
CONCLUSION: No differences in pCR and survival outcomes were seen between ACEI/ARB users and non-users among breast cancer patients receiving neoadjuvant chemotherapy. ARB use may be associated with improved RFS. Further research is needed to validate this finding.
Keywords: ACE inhibitor, ARB, breast cancer, neoadjuvant chemotherapy
Chae YK, Brown EN, Lei X, Melhem-Bertrandt A, Giordano SH, Litton JK, Hortobagyi GN, Gonzalez-Angulo AM, Chavez-MacGregor M. Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes. J Cancer 2013; 4(7):549-556. doi:10.7150/jca.6888. Available from http://www.jcancer.org/v04p0549.htm