If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  ACE Inhibitors and ARBs May Protect Against Breast Cancer Recurrence: Presented at SABCS By Wayne Kuznar SAN ANTONIO, Tex -- December 13, 2009 -- Women with a history of breast cancer who use angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) have fewer breast cancer recurrences than those not using ACE inhibitors or ARBs, according to a retrospective review presented here at the 32nd Annual San Antonio Breast Cancer Symposium (SABCS). Further, patients with breast cancer who used ACE inhibitors/ARBs for the treatment of hypertension had a reduced risk of dying compared with the subset of patients with hypertension not being treated with ACE inhibitors or ARBs, reported Young Kwang Chae, MD, Albert Einstein Medical Center, Philadelphia, Pennsylvania. The renin-angiotensin pathway plays an important role in promoting cancer growth, explained Dr. Chae on December 11. The AT1 receptor is functionally expressed in several tumour types, including ovarian cancer. Prior retrospective studies have documented lower cancer incidence among users of ACE inhibitors/ARBs compared with nonusers, and 1 randomised trial showed a protective effect of these agents on the development of major skin cancers, he said. No studies, however, have looked at the relationship between ACE inhibitors/ARBs and cancer recurrence. For the study, Dr. Chae and colleagues reviewed the medical records of female patients diagnosed with stage II/III breast cancer at Albert Einstein between 1999 and 2005, and who later reached no evident disease (NED) after curative therapy. A user of ACE inhibitors/ARBs was defined as a patient who took the medication in the NED stage for at least 6 months. The mean follow-up period was 4.4 years and the maximum follow-up was 9.8 years. About one-fourth (23.3%) of the patients, overall, were prescribed an ACE inhibitor or ARB, including 49.0% of the 164 patients with hypertension. Fourteen percent (23/164) of the women who took either an ACE inhibitor or ARB developed a tumour recurrence, compared with 23.3% (125/541) of nonusers (P = .01). The 5-year disease-free survival was 0.85 in the ACE inhibitor/ARB users and 0.756 in the nonusers (P < .01). “There was not an overall reduction in mortality [with ACE inhibitor/ARB use], but if you look only at the subset with blood pressure, I found a statistically significant reduction in the hazard ratio for mortality,” said Dr. Chae. Women who were treated with an ACE inhibitor or ARBs for the indication of hypertension had a 57% reduction in the adjusted risk of mortality compared with those women with hypertension who were not treated with an ACE inhibitor or ARB (P < .01). “It’s not really clear how high blood pressure itself plays a role in disease progression or recurrence,” said Dr. Chae. “If there is, this tells us that using an ACE inhibitor or ARB, whether through antiangiogenesis or anti-inflammation, whatever pathway it touches, is really beneficial for patients with high blood pressure and breast cancer with no evidence of disease. It might be a matter of sample size.” The implication is that an ACE inhibitor or ARB might be a better choice of antihypertensive therapy than other antihypertensive drugs in women with a history of breast cancer, he said. [Presentation title: Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers May Reduce Breast Cancer Recurrence. Abstract 3121]
|
