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

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

*Corresponding author for this work

Research output: Contribution to journalArticle

28 Scopus citations

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. Ofthem, 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.

Original languageEnglish (US)
Pages (from-to)549-556
Number of pages8
JournalJournal of Cancer
Volume4
Issue number7
DOIs
StatePublished - Aug 30 2013

Keywords

  • Ace Inhibitor
  • Arb
  • Breast Cancer
  • Neoadjuvant Chemotherapy

ASJC Scopus subject areas

  • Oncology

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    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