β-Blocker use and mortality in cancer patients: systematic review and meta-analysis of observational studies

Zhong, Shanliang; Yu, Dandan; Zhang, Mengjie; Chen, Xiu; Yang, Su-Jin; Tang, Jinhai; Zhao, Jinmin; Wang, Shukui

doi:10.1097/cej.0000000000000192

Cited by 57 publications

(33 citation statements)

References 54 publications

(111 reference statements)

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“…Zhong et al performed a systematic review and meta-analysis of observational studies of beta-blocker use and cancer mortality [77]. They identified 24 relevant studies that had reported results by May 2015, involving 76 538 patients.…”

Section: Human Datamentioning

confidence: 99%

Repurposing Drugs in Oncology (ReDO)—Propranolol as an anti-cancer agent

Pantziarka

Bouche

Sukhatme³

et al. 2016

ecancer

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Propranolol (PRO) is a well-known and widely used non-selective beta-adrenergic receptor antagonist (beta-blocker), with a range of actions which are of interest in an oncological context. PRO displays effects on cellular proliferation and invasion, on the immune system, on the angiogenic cascade, and on tumour cell sensitivity to existing treatments. Both pre-clinical and clinical evidence of these effects, in multiple cancer types, is assessed and summarised and relevant mechanisms of action outlined. In particular there is evidence that PRO is effective at multiple points in the metastatic cascade, particularly in the context of the post-surgical wound response. Based on this evidence the case is made for further clinical investigation of the anticancer effects of PRO, particularly in combination with other agents. A number of trials are on-going, in different treatment settings for various cancers.

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Section: Human Datamentioning

confidence: 99%

Repurposing Drugs in Oncology (ReDO)—Propranolol as an anti-cancer agent

Pantziarka

Bouche

Sukhatme³

et al. 2016

ecancer

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“…Indeed, this analysis objectively confirmed the latest development in this topic. All the previous three articles drew a conclusion that beta-blocker use could prolong the survival of cancer patients, 44 – 46 but our current analysis showed an opposite conclusion that there is generally no relationship between beta-blocker use and cancer prognosis.…”

Section: Discussionmentioning

confidence: 53%

The effects of beta-blocker use on cancer prognosis: a meta-analysis based on 319,006 patients

Na¹,

Qiao²,

Hao³

et al. 2018

OTT

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BackgroundBeta-blockers are antihypertensive drugs and have shown potential in cancer prognosis. However, this benefit has not been well defined due to inconsistent results from the published studies.MethodsTo investigate the association between administration of beta-blocker and cancer prognosis, we performed a meta-analysis. A literature search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify all relevant studies published up to September 1, 2017. Thirty-six studies involving 319,006 patients were included. Hazard ratios were pooled using a random-effects model. Subgroup analyses were conducted by stratifying ethnicity, duration of drug use, cancer stage, sample size, beta-blocker type, chronological order of drug use, and different types of cancers.ResultsOverall, there was no evidence to suggest an association between beta-blocker use and overall survival (HR=0.94, 95% CI: 0.87–1.03), all-cause mortality (HR=0.99, 95% CI: 0.94–1.05), disease-free survival (HR=0.59, 95% CI: 0.30–1.17), progression-free survival (HR=0.90, 95% CI: 0.79–1.02), and recurrence-free survival (HR=0.99, 95% CI: 0.76–1.28), as well. In contrast, beta-blocker use was significantly associated with better cancer-specific survival (CSS) (HR=0.78, 95% CI: 0.65–0.95). Subgroup analysis generally supported main results. But there is still heterogeneity among cancer types that beta-blocker use is associated with improved survival among patients with ovarian cancer, pancreatic cancer, and melanoma.ConclusionThe present meta-analysis generally demonstrates no association between beta-blocker use and cancer prognosis except for CSS in all population groups examined. High-quality studies should be conducted to confirm this conclusion in future.

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“…Prolonged BB exposure can also lead to β receptor upregulation, hampering the effectiveness of BB (10). This phenomenon has been demonstrated in observational studies where post-diagnostic BB use was associated with significant improvements in survival outcomes compared to pre-diagnostic BB use (27). In the present study, the sample of patients on non-selective BB was insufficient for an appropriately powered subgroup analysis (n = 51), and data on the length of prior BB use was not available.…”

Section: Discussionmentioning

confidence: 97%

The Influence of Pre-Existing Beta-Blockers Use on Survival Outcomes in HER2 Positive Advanced Breast Cancer: Pooled Analysis of Clinical Trial Data

et al. 2020

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Introduction: Beta-blockers (BB) are commonly used to manage cardiovascular disease and may have benefits in controlling complications of anti-HER2 therapies. This study aimed to evaluate the association of pre-existing BB use with survival outcomes in patients initiating anti-HER2 therapy for advanced breast cancer (ABC). Materials and Methods: Data from clinical trials EMILIA, TH3RESA, MARIANNE, and CLEOPATRA was pooled. Cox proportional analysis was used to assess the association between pre-existing BB use with survival outcomes in patients initiating anti-HER2 therapies. Results: Of the 2,777 patients with HER2 positive ABC, 266 were using a BB at the time of anti-HER2 therapy initiation. BB use was associated with worse overall survival (OS) (adjusted HR = 1.27, 95% CI: 1.04-1.55). Sensitivity analysis in patients with pre-existing cardiovascular disease (CVD) also indicated that BB use was associated with worse OS (1.29, 1.02-1.63). Conclusion: In large high-quality data, BB use at the time of anti-HER2 therapy initiation for ABC was independently associated with worse OS, regardless of CVD status. The finding is contrary to pre-study hypotheses and findings in other BC subtypes. Future research should aim to gain a deeper understanding of the effects of BBs on specific BC subtypes, cancer types, and cancer treatments.

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β-Blocker use and mortality in cancer patients: systematic review and meta-analysis of observational studies

Cited by 57 publications

References 54 publications

Repurposing Drugs in Oncology (ReDO)—Propranolol as an anti-cancer agent

Repurposing Drugs in Oncology (ReDO)—Propranolol as an anti-cancer agent

The effects of beta-blocker use on cancer prognosis: a meta-analysis based on 319,006 patients

The Influence of Pre-Existing Beta-Blockers Use on Survival Outcomes in HER2 Positive Advanced Breast Cancer: Pooled Analysis of Clinical Trial Data

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