J Cancer 2013; 4(7):549-556. doi:10.7150/jca.6888

Research Paper

Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes

Young Kwang Chae1, Erika N. Brown2, Xiudong Lei3, Amal Melhem-Bertrandt2, Sharon H. Giordano2, Jennifer K. Litton2, Gabriel N. Hortobagyi2, Ana M. Gonzalez-Angulo2, Mariana Chavez-MacGregor2✉

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

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How to cite this article:
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