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. 2013 Oct 1;6(5):539-45.
doi: 10.1593/tlo.13346. eCollection 2013.

Exposure to ACEI/ARB and β-Blockers Is Associated with Improved Survival and Decreased Tumor Progression and Hospitalizations in Patients with Advanced Colon Cancer

Diana R Engineer  1 , Basil O Burney, Teresa G Hayes, Jose M Garcia
Affiliations

Exposure to ACEI/ARB and β-Blockers Is Associated with Improved Survival and Decreased Tumor Progression and Hospitalizations in Patients with Advanced Colon Cancer

Diana R Engineer et al. Transl Oncol. .

Abstract

Background: Advanced colon cancer is associated with weight loss and decreased survival. Studies suggest that angiotensin and β-adrenergic blockade decrease colon cancer progression and ameliorate weight loss. This study aims to determine whether exposure to β-adrenoceptor blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) is associated with decreased mortality, tumor progression, number of hospitalizations, or weight loss in colorectal cancer.

Methods: Retrospective chart review included patients with advanced colorectal cancer. Survival, stage, hospitalization, cancer progression, cancer treatment, and body weight history were collected.

Results: Two hundred sixty-two of 425 new stage III to IV colorectal cancer cases reviewed met the study criteria. Those exposed to ACEI/ARB, BB, or both were more likely to have diabetes, hypertension, and stage III colorectal cancer. Adjusting for age, presence of hypertension and diabetes, and stage, ACEI/ARB + BB exposure was associated with decreased mortality compared to unexposed individuals [hazard ratio (HR) = 0.5, confidence interval (CI) = 0.29-0.85; Cox regression, P = .01]. Fewer total and cancer-related hospitalizations and decreased cancer progression in the ACEI/ARB + BB group versus the unexposed group (HR = 0.59, CI = 0.36-0.99, P = .047) were seen. Exposure did not affect weight changes; furthermore, body weight changes from both prediagnosis and at diagnosis to 6, 12, 18, and 24 months postdiagnosis predicted survival.

Conclusions: We have observed an association between exposure to a combination of ACEI/ARB + BB and increased survival, decreased hospitalizations, and decreased tumor progression in advanced colorectal cancer. Future studies will be needed to replicate these results and generalize them to broader populations. Determination of causality will require a randomized controlled trial.

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Figures

Figure 1
Figure 1
Overview of study selection. CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; tx, treatment.
Figure 2
Figure 2
Exposure and survival—HR compared to unexposed subjects. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β-adrenoceptor blocker.
Figure 3
Figure 3
Exposure and tumor progression. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β-adrenoceptor blocker. P value was obtained using χ2 test, comparing ACEI/ARB + BB to unexposed group.
Figure 4
Figure 4
Exposure and tumor progression—HR compared to unexposed subjects. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β-adrenoceptor blocker.
Figure 5
Figure 5
Total and cancer-related hospitalizations. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β-adrenoceptor blocker. P values were compared to unexposed. Hospitalization ratio was calculated as the ratio of number of hospitalizations (total or cancer related) per year survived.
Figure 6
Figure 6
Exposure and weight change. BMI, body mass index; dx, diagnosis; mo, months; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β-adrenoceptor blocker.
Figure 7
Figure 7
Weight change and survival—HR; predx, prediagnosis; DX, diagnosis; mo, month.
See this image and copyright information in PMC

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