Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes

Chae, Young Kwang; Brown, Erika N.; Lei, Xiudong; Melhem-Bertrandt, Amal; Giordano, Sharon H.; Litton, Jennifer K.; Hortobagyi, Gabriel N.; Gonzalez-Angulo, Ana M.; Chavez-MacGregor, Mariana

doi:10.7150/jca.6888

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J Cancer 2013; 4(7):549-556. doi:10.7150/jca.6888 This issue Cite

Research Paper

Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes

Young Kwang Chae¹, Erika N. Brown², Xiudong Lei³, Amal Melhem-Bertrandt², Sharon H. Giordano², Jennifer K. Litton², Gabriel N. Hortobagyi², Ana M. Gonzalez-Angulo², Mariana Chavez-MacGregor^2✉

1. Division of Cancer Medicine,
2. Department of Breast Medical Oncology,
3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Citation:

Chae YK, Brown EN, Lei X, Melhem-Bertrandt A, Giordano SH, Litton JK, Hortobagyi GN, Gonzalez-Angulo AM, Chavez-MacGregor M. Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes. J Cancer 2013; 4(7):549-556. doi:10.7150/jca.6888. https://www.jcancer.org/v04p0549.htm

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Abstract

BACKGROUND: ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may have anti-tumor properties. We investigated whether the use of ACEI/ARBs affects the clinical outcomes of primary breast cancer patients receiving taxane and anthracycline-based neoadjuvant chemotherapy.

METHODS: We included 1449 patients with diagnosis of invasive primary breast cancer diagnosed at the MD Anderson Cancer Center between 1995 and 2007 who underwent neoadjuvant chemotherapy. Of them, 160 (11%) patients were identified by review of their medical record, as ACEI/ARBs users. We compared pathologic complete response (pCR) rates, relapse-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) between ACEI/ARB users and non-users. Descriptive statistics and Cox proportional hazards model were used in the analyses.

RESULTS: There was no difference in the pCR rates between ACEI/ARB users and non-users (16% vs 18.1%, p-=0.50). After adjustment for important demographic and clinical characteristics, no significant differences between ACEI/ARB users and nonusers were observed in RFS (HR=0.81; 95% CI=0.54-1.21), DSS (HR=0.83; 95% CI=0.52-1.31), or OS (HR=0.91; 95% CI =0.61-1.37). In a subgroup analysis, the 5-year RFS was 82% in ARB only users versus 71% in ACEI/ARB non-users (P=0.03). In the multivariable analysis, ARB use was also associated with a decreased risk of recurrence (HR=0.35; 95% CI=0.14-0.86). No statistically significant differences in DSS or OS were seen.

CONCLUSION: No differences in pCR and survival outcomes were seen between ACEI/ARB users and non-users among breast cancer patients receiving neoadjuvant chemotherapy. ARB use may be associated with improved RFS. Further research is needed to validate this finding.

Keywords: ACE inhibitor, ARB, breast cancer, neoadjuvant chemotherapy

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APA

Chae, Y.K., Brown, E.N., Lei, X., Melhem-Bertrandt, A., Giordano, S.H., Litton, J.K., Hortobagyi, G.N., Gonzalez-Angulo, A.M., Chavez-MacGregor, M. (2013). Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes. Journal of Cancer, 4(7), 549-556. https://doi.org/10.7150/jca.6888.

ACS

Chae, Y.K.; Brown, E.N.; Lei, X.; Melhem-Bertrandt, A.; Giordano, S.H.; Litton, J.K.; Hortobagyi, G.N.; Gonzalez-Angulo, A.M.; Chavez-MacGregor, M. Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes. J. Cancer 2013, 4 (7), 549-556. DOI: 10.7150/jca.6888.

NLM

CSE

Chae YK, Brown EN, Lei X, Melhem-Bertrandt A, Giordano SH, Litton JK, Hortobagyi GN, Gonzalez-Angulo AM, Chavez-MacGregor M. 2013. Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes. J Cancer. 4(7):549-556.

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