Perioperative Administration of an Intravenous Beta-Blocker Landiolol Hydrochloride in Patients with Lung Cancer: A Japanese Retrospective Exploratory Clinical Study

Abstract

Beta-blockers have been reported to improve prognosis for various cancers, but the usefulness of perioperative administration remains unclear. To assess the efficacy of perioperative administration of landiolol hydrochloride, an intravenous beta-blocker, for lung cancer, we conducted a single-center, retrospective study. This study included patients who participated in a research conducted by Nippon Medical School Hospital from August 2012 to November 2013. The main selection criteria were males and females younger than 85 years old who have undergone anatomic lung resection for lung malignancies. Fifty-seven patients, 28 in the landiolol group and 29 in the control group, were included. The postoperative relapse-free survival rate at 2 years was 0.89 (95% CI, 0.78–1.01) in the landiolol group and 0.76 (95% CI, 0.60–0.91) in the control group (Chi-squared test; P = 0.1828). The relapse-free survival rate tended to be higher in the landiolol group than in the control. Hazard ratio for relapse-free survival in the landiolol group compared to the control was 0.41 (95% CI, 0.13–1.34), demonstrating that relapse free survival was prolonged in the landiolol group (log-rank test; P = 0.1294). It was suggested that relapse-free survival was prolonged when landiolol hydrochloride was administered from the induction to completion of anesthesia. Further studies are needed to confirm our findings.

Postoperative atrial fibrillation does not impact on overall survival after esophagectomy in patients with thoracic esophageal cancer: results from a randomized, double-blind, placebo-controlled trial

“…This RCT has already proven a significantly lower serum IL-6 level in the landiolol group than in the placebo group during the early postoperative period [8]. In addition, landiolol hydrochloride may inhibit attachment of circulating tumor cells to vascular endothelial cells [21,28]. In this study, however, the recurrence and survival rates were similar with and without administration of landiolol.…”

“…Invasion due to esophagectomy induces an increase in inflammatory cytokines. Perioperative inflammation is generally accepted to be related to tumor recurrence [8,21,22]. Landiolol hydrochloride has strong antiinflammatory effects, it therefore not only reduces postoperative complication rates, but may also help to reduce tumor recurrence after esophagectomy [8].…”

Beta-blocker and survival in patients with lung cancer: A meta-analysis

“…In a retrospective study with 77 patients of stage IIIa NSCLC treated with neoadjuvant chemoradiation and subsequent surgery, BB users were associated with a trend of improved OS at 1 year compared with the non-users in univariate analysis (p = 0.08) [ 39 ]. Another study with 57 lung cancer patients showed that perioperative intravenous administration of an ultra-short acting SBB landiolol prolonged relapse-free survival in these patients [ 40 ], and a phase III RCT has been started accordingly [ 41 ]. Results of future prospective studies and RCTs are expected to provide more reliable evidence regarding the association between BB use and OS in patients with lung cancer, preferably according in different histopathological type.…”

Anaesthesia and cancer: can anaesthetic drugs modify gene expression?

“…Apparently, propofol displays a different profile since its protective effects are exerted by other mechanisms, including anti-inflammatory effects, COX-2 inhibition and PGE-2 reduction, increased cytotoxic T lymphocyte activity, and decreased pro-inflammatory cytokines [35]. Propofol does not affect the Th1/Th2 ratio [36], and is weakly bound to β-adrenoreceptor, producing a β-blocking effect that improves anti-tumour immunity and preserves the function of NK cells [37]. Patients receiving perioperative β-blockers have a lower recurrence of metastases after surgery [38].…”