Beta-blockers related to better outcomes in ovarian cancer patients28 Aug 2015
Patients with ovarian cancer lived more than twice as long if they received beta-blockers for hypertension or other conditions unrelated to the cancer, a retrospective review of 1,425 patients showed.
Overall, coincidental treatment with beta-blockers only modestly improved survival as compared with patients who did not take the cardiovascular drugs. However, the subgroup of patients treated with nonselective beta-blockers had a median overall survival of 95 months versus 38 months for patients treated with beta-1 selective agents.
“This study provides new evidence that it is really the broad beta-blockers that perhaps are related to better outcomes" the study's senior author, Anil K. Sood, MD, of the University of Texas MD Anderson Cancer Center in Houston reported. "The beta 1-specific blockers were not particularly effective in terms of better outcomes." The effect of nonselective beta-blockers on the cancer patients' survival was unrelated to the drugs effect on hypertension, which was negatively associated with survival.
Study’s patient characteristics
To examine the selectivity issue in greater detail, investigators performed a multi-institutional retrospective chart review to identify patients with newly diagnosed epithelial ovarian cancer treated with at least one cycle of platinum-based chemotherapy. Beta-blocker use and selectivity were determined from chart review.
The search yielded a study population of 1,425 patients, of whom 269 had a history of beta-blocker use. The beta-blocker cohort comprised 75 patients who received nonselective agents and 194 who received cardioselective beta-blockers.
Patients treated with beta-blockers were older, had a higher body mass index, and had a higher prevalence of hypertension. More than 90% of patients underwent surgery followed by adjuvant chemotherapy, whereas beta-blocker use was more common among patients who had neoadjuvant chemotherapy (P=0.005). Older age at cancer diagnosis, advanced FIGO stage, a diagnosis of hypertension, and receipt of neoadjuvant chemotherapy were associated with significantly lower overall survival.
Improved disease-specific survival with nonselective beta-blockers
During the first year after diagnosis, patients treated with any type of beta-blocker had improved disease-specific survival (DSS), regardless of whether they had hypertension. By 5 years, patients with hypertension and a history of treatment with selective beta-blockers had significantly worse DSS. Use of selective beta-blockers in the absence of hypertension did not significantly affect DSS.
Patients treated with nonselective beta-blockers had improved DSS regardless of whether they had a history of hypertension, but DSS improved to an even greater extent in the subgroup of patients who did not have hypertension.
Beta-blocker use of any type was associated with improved survival
The analysis of overall survival showed that beta-blocker use of any type was associated with improved survival. Analysis of survival type beta-blocker selectivity showed that patients treated with selective agents had slightly inferior survival compared with patients who received no beta blocker therapy. In contrast, the 75 patients who received nonselective beta-blockers had significant improvement in overall survival.
Examination of beta-blocker use and co morbidities showed that had improved patients with diabetes survival if they received nonselective beta-blockers as compared with patients who received selective agents. Patients without hypertension had a median overall survival of 112 months when treated with a nonselective beta-blocker, which did not differ significantly from the overall survival of nonusers.Source: MedPage Today