Incidental Use of Beta-Blockers Is Associated with Outcome of Metastatic Colorectal Cancer Patients Treated with Bevacizumab-Based Therapy: A Single-Institution Retrospective Analysis of 514 Patients

Abstract

Background: Beta-adrenergic signalling plays an important role in several cancer-related processes, including angiogenesis. The impact of beta-blocker use on prognosis of cancer patients treated with antiangiogenic agents is unclear. The aim of this study was to evaluate the association between the incidental use of beta-blockers and the outcomes of patients with metastatic colorectal cancer (mCRC) treated with bevacizumab-based therapy. Methods: Clinical data from 514 mCRC patients treated with bevacizumab between 2005 and 2019 were analysed retrospectively. The association of progression-free survival (PFS) and overall survival (OS) with the incidental use of beta-blockers and other common antihypertensive drugs was assessed. Results: The median PFS and OS for patients using beta-blockers was 11.40 (95% confidence interval (CI) 10.10–13.61) months and 26.8 (95% CI 22.2–32.2) months compared with 8.30 (95% CI 7.80–9.57) and 21.0 (95% CI 17.8–23.8) months for patients not using beta-blockers (p = 0.006 and p = 0.009, respectively). In the Cox multivariate analysis, the use of beta-blockers was a significant factor predicting both PFS (hazard ratio (HR) = 0.763 (95% CI 0.606–0.960), p = 0.021) and OS (HR = 0.730 (95% CI 0.560–0.951), p = 0.020). Conclusions: The results of the present retrospective study suggest that there is a significant association between the use of beta-blockers and favourable outcomes of mCRC patients treated with bevacizumab-based therapy.

Impact of Polypharmacy for Chronic Ailments in Colon Cancer Patients: A Review Focused on Drug Repurposing

“…Fiala et al [ 18 ] reported the clinical outcome of 514 mCRC patients treated with bevacizumab, stratified by incidental use of beta blockers; 126 patients (24%) were incidental beta-blocker users. Median progression free survival (mPFS) for beta-blocker users vs. not were respectively 11.4 vs. 8.3 months ( p = 0.006), whereas mOS were respectively 26.8 vs. 21.0 ( p = 0.009).…”

The Use of Antihypertensive Drugs as Coadjuvant Therapy in Cancer

“…For metastatic colorectal cancer, an observational study with 514 reported that β-blockers in combination with bevacizumab, a monoclonal antibody directed against VEGF-A, increased median overall survival and progression-free survival compared to treatment only with bevacizumab ( 143 ).…”

Effects of Antihypertensive Drugs Use on Risk and Prognosis of Colorectal Cancer: A Meta-Analysis of 37 Observational Studies

“…A study of 14,166 patients indicated that long-term diuretics therapy might increase colon cancer-specific mortality ( Tenenbaum et al, 2001 ). A population-based study, with a follow-up time of 6.6 years, supported that pre- or post-diagnostic BB intake was not related with colorectal cancer prognosis ( Jansen et al, 2017 ), but a recent study suggested BB might improve overall survival (OS) ( Fiala et al, 2019 ). In addition, a cohort study from Shanghai proposed that ARB and BB usage were associated with better survival in colorectal cancer patients ( Cui et al, 2019 ).…”