Concurrent use of statins and neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and meta-analysis

McKechnie, Tyler; Talwar, Gaurav; Lee, Yung; Levine, Oren; Eskicioglu, Cagla

doi:10.1007/s00384-021-04016-3

Cited by 3 publications

(3 citation statements)

References 64 publications

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“…The event rate for pCR was six (7.6%); thus, the study was underpowered for detecting any signi cant association between clinicopathologic variables and pCR. 14 Second, this was a retrospective study and therefore has the inherent risk of residual confounding and selection bias. For example, we did not explore time to surgery as a predictor variable associated with pCR.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 More recently, statins have demonstrated bene t in oncology patients. 13,14 In colorectal cancer, statins may interfere with Ras oncogene activation, thus inhibiting tumor cell proliferation. 15 Ras oncogene activation has also been associated with reduced radio-sensitivity in rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20] A recent systematic review and meta-analysis demonstrated a four percent absolute increase in pCR prevalence in patients taking statins compared to patients not taking statins, which was not statistically signi cant. 14 Additionally, concurrent statin use may contribute to reduced treatment-related toxicity as they have demonstrated the ability to modulate acute radiotherapy-related tissue in ammatory response through inhibition of endothelial cell damage and in ammatory cytokine activation. 21,22 A phase II randomized clinical trial (RCT) is currently ongoing examining the impact of concurrent statin use and long-course neoadjuvant chemoradiation.…”

Section: Introductionmentioning

confidence: 99%

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Statin therapy in patients undergoing short-course neoadjuvant radiotherapy for rectal cancer: A retrospective cohort study

McKechnie

Schep

Cardenas

et al. 2023

Preprint

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Purpose There is a potential benefit with concurrent statin use and neoadjuvant therapy for rectal cancer. The impact of statins on pathologic response following short-course neoadjuvant radiation has yet to be studied. This study aimed to elucidate the impact statin use on tumor response to short-course neoadjuvant radiation. Methods This retrospective cohort study included patients receiving short-course neoadjuvant radiation and subsequently undergoing oncologic resection for stage II/III rectal adenocarcinoma from 2014–2020. Exclusion criteria included recurrent disease, total neoadjuvant therapy (TNT), and oncologic resection less than six weeks after neoadjuvant therapy. The primary outcome was pathologic complete response (pCR). Secondary outcomes included graded pathologic response and incidence of radiation-associated toxicity. Univariable logistic regressions and stepwise multivariable logistic regressions were performed. Results Seventy-nine patients (mean age: 68.6 ± 11.2 years, 39.2% female) met inclusion criteria. Prior to neoadjuvant therapy, median T-stage was 3 (range: 1–4), median N-stage was 1 (range: 0–2), and mean tumor distance from the anal verge was 6.3cm (± 2.9). Thirty-five patients (44.3%) were using statins. Overall, 7.6% experienced pCR and 29.1% had no treatment response on pathology. Radiation-associated toxicity was 43.0%. Statin use was not associated with pCR (OR 2.71, 95%CI 0.47–15.7, p = 0.27), however on stepwise multivariable logistic regression, statin use was associated with decreased prevalence of no response (OR 0.08, 95%CI 0.01–0.43, p = 0.003). Conclusions Statins may offer a synergistic effect when given concurrently with short-course neoadjuvant radiation for rectal cancer. Further prospective study evaluating the use of statins in conjunction with neoadjuvant therapy is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Statin therapy in patients undergoing short-course neoadjuvant radiotherapy for rectal cancer: A retrospective cohort study

McKechnie

Schep

Cardenas

et al. 2023

Preprint

Self Cite

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Concurrent Use of Statins in Patients Undergoing Curative Intent Treatment for Triple Negative Breast Cancer: A Systematic Review and Meta-Analysis

McKechnie,

Brown,

Lovrics

et al. 2024

Clinical Breast Cancer

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The impact of statins on melanoma survival: a systematic review and meta-analysis

McKechnie,

Talwar,

Grewal

et al. 2024

Melanoma Research

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Statin use may decrease recurrence and improve survival in patients with melanoma. In this systematic review and meta-analysis, we examine the current body of literature concerning the use of statins as an adjunctive therapy in melanoma, Medline, EMBASE, CENTRAL, and PubMed were systematically searched from inception through to April 2023. Studies were included if they compared patients with melanoma receiving and not receiving statin therapy concurrently with their oncologic treatment in terms of long-term oncologic outcomes. The primary outcome was 5-year overall survival (OS). Meta-analyses was performed with DerSimonian and Laird random effects. Risk of bias was assessed with the ROBINS-I and GRADE was used to assess certainty of evidence. From 952 citations, eight non-randomized studies were identified. Included studies were conducted between 2007 and 2022. Random effects meta-analysis of adjusted hazard ratios from three studies suggested an improvement in 5-year OS with statin use with wide 95% confidence intervals (CIs) crossing the line of no effect (hazard ratio 0.87, 95% CI: 0.73–1.04, P = 0.12, I 2 = 95%, very-low certainty). Outcome reporting was heterogeneous across all other oncologic outcomes such that pooling of data was not possible. Risk of bias was serious for seven studies and moderate for one study. This systematic review of studies evaluating the impact of statin use on survival in patients with melanoma found a 13% reduction in risk of death at 5 years from diagnosis – a point estimate suggesting benefit. However, the wide 95% CIs and resultant type II error risk create significant uncertainty.

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Concurrent use of statins and neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and meta-analysis

Cited by 3 publications

References 64 publications

Statin therapy in patients undergoing short-course neoadjuvant radiotherapy for rectal cancer: A retrospective cohort study

Statin therapy in patients undergoing short-course neoadjuvant radiotherapy for rectal cancer: A retrospective cohort study

Concurrent Use of Statins in Patients Undergoing Curative Intent Treatment for Triple Negative Breast Cancer: A Systematic Review and Meta-Analysis

The impact of statins on melanoma survival: a systematic review and meta-analysis

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