Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in cancer progression and survival: a systematic review

Abstract

There is some evidence to suggest that ACEI or ARB use may be associated with improved outcomes in cancer patients. Larger, more robust studies are required to explore this relationship further.

Association between AT1 and AT2 angiotensin II receptor expression with cell proliferation and angiogenesis in operable breast cancer

“…Although it is unclear whether the promising preclinical activity of both ACE inhibitors (ACE-I) and ANG receptor blockers (ARB) have clinical implications beyond of the benefit in cardiovascular morbidity and mortality [41], there have been reports that have confirmed the use of ACE-I and ARB are associated with favorable outcomes in breast cancer [42,43], although other studies have not confirmed these findings [44]. In a retrospective study from MD Anderson Cancer Center that included 1449 patients with breast cancer who underwent neoadjuvant chemotherapy, non-difference in pathologic complete response between ACE-I/ARB users and nonusers were reported.…”

Comorbidities and Their Management: Potential Impact on Breast Cancer Outcomes

“…For example, metformin for treatment of type II diabetes may improve insulin and other metabolic parameters that have been associated with poor breast cancer outcomes (Goodwin et al 2012 ); the effect of metformin on breast cancer outcomes and on co-morbidities is being examined in a fully accrued Phase III trial of 3,649 women with early stage breast cancer (Goodwin et al 2011 ), and has been associated with reduced breast cancer mortality in population-based studies Hou et al 2013 ). Other medications that may improve breast cancer outcomes include angiotensinconverting-enzyme (ACE) inhibitors and angiotensin receptor blockers for the treatment of hypertension and diabetic nephropathy (Mc Menamin et al 2012 ;Barron et al 2011 ), statins for the management of dyslipidemia (Holmes and Chen 2012 ;Ahern et al 2011 ;Kwan et al 2008 ;Nickels et al 2013 ), and aspirin and NSAIDs for treatment of infl ammatory conditions (Holmes and Chen 2012 ;Kwan et al 2007 ;Blair et al 2007 ). This raises the possibility that use of these medications for management of comorbidities may have direct benefi cial effects on breast cancer outcomes.…”

Incidental Receipt of Cardiac Medications and Survival Outcomes Among Patients With Stage III Non–Small-Cell Lung Cancer After Definitive Radiotherapy

“…[9][10][11][12][13] Preclinical findings have implicated cardiac medications such as angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), which are in wide use as antihypertensive agents, in tumor growth and cancer progression. [14][15][16][17][18] Some clinical investigations indicated that receipt of ACEIs or ARBs was associated with improved outcomes among patients with prostate, hepatocellular, pancreatic, breast, or bladder cancer, [19][20][21][22][23][24] but others have not. [25][26][27][28] Moreover, few studies have described the effect of ACEIs on survival in lung cancer; the single study done to date, a retrospective analysis of 287 patients, revealed that patients receiving ACEIs or ARBs had slightly longer median survival times (3.1 months) than did patients who were not receiving these drugs.…”