Blood Pressure Medication Could Affect Survival in Pancreatic Cancer
PHILADELPHIA – Pancreatic cancer is an extremely difficult cancer to treat with only about 11% of patients surviving five years past diagnosis. However, new research from Thomas Jefferson University shows that medications commonly prescribed to treat high blood pressure may also impact survival in patients with pancreatic cancer. The results are from the largest population-based study of this question and suggest that a broader, prospective clinical trial may be warranted to confirm the results and potentially change clinical practice.
“These medications for hypertension do not have a lot of side effects – far fewer than chemotherapy, for example – and yet our data suggests that they might extend life in patients with pancreatic cancer,” says first author Scott Keith, PhD, associate professor of Biostatistics at Thomas Jefferson University. “Clinical studies will be required to determine just how much these approved, and inexpensive therapies can extend life, and our data make a strong case for investing in further research.”
The researchers led by Dr. Keith and Vittorio Maio, a professor in the College of Population Health and managing director in the Asano-Gonnella Center for Research in Medical Education and Health Care at Jefferson, were able to examine data on 3.7 million adults living in a region of Northern Italy because of the availability of a comprehensive, population-based longitudinal healthcare database from a public health care system. Their analysis is the largest retrospective study to look at survival in pancreatic patients as it relates to blood pressure medication usage.
A total of 8,158 pancreatic cancer patients were identified between 2003 and 2011 from this region. The health care records from the database allowed the researchers to look at a patient’s full medical reimbursement record over time and adjust comparison groups for age, gender, comorbid conditions, cancer severity at diagnosis, cancer treatments, additional medication usage and other variables. The team was able to compare pancreatic cancer patients who had taken certain classes of hypertension medication in a model to predict their mortality risk compared to otherwise similar patients who had not taken those hypertension medications.
Earlier research in animals suggested that RAS-type therapies, which include ARB drugs such as valsartan and losartan, and ACE inhibitors, which include benazepril, ramipril or lisinopril, might slow pancreatic cancer growth. Several small clinical trials suggested the same effect, although the numbers of patients in those studies were too small to draw broad conclusions. These two medications interact with the angiotensin system, which is normally responsible for narrowing blood vessels, but have also been shown to interact with cancer-growth pathways.
The current results showed that the patients who took ARBs after their pancreatic cancer diagnosis had a 20% lower risk of mortality than those who did not and similar ARBs use showed a 28% lower risk of mortality in the subgroup of patients who had been treated with surgery for their cancer. Those taking ACE inhibitors experienced a 13% lower risk of mortality in the first three years after diagnosis than those who did not.
“We can’t predict reliably how much time these medications might extend life,” says Dr. Maio. “A randomized clinical trial would be necessary to determine that benefit. But these data suggest that people with pancreatic cancer who are taking ARB or ACE inhibitors are living longer than those who aren’t.”
“We think these data strongly support investing in a clinical study to further explore the use of these inexpensive and safe medications in patients diagnosed with pancreatic cancer,” says Dr. Keith. “We urge academic institutions, cancer organizations and the pharmaceutical industry to work together to establish a collaborative and well-resourced initiative to study the potential therapeutic effect of these antihypertensive medications on improving the care of pancreatic cancer patients,” added Dr. Maio.
This study was supported, in part, by an Institutional Research Grant (IRG-08-060-04) from the American Cancer Society. The authors report no conflicts of interest.
Article reference: Scott W. Keith, Vittorio Maio, Hwyda A. Arafat, Matthew Alcusky, Thomas Karagiannis, Carol Rabinowitz, Harish Lavu, and Daniel Z. Louis, “Angiotensin blockade therapy and survival in pancreatic cancer: a population study,” BMC Cancer, DOI: 10.1186/s12885-022-09200-4.
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