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Angiotensin System Inhibitors Improve Survival in Hypertensive Patients With Metastatic Renal Cell Carcinoma

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Key Points

  • The overall survival for hypertensive patients with metastatic renal cell carcinoma receiving angiotensin system inhibitors was 27 months vs 17 months for non–angiotensin system inhibitor users.
  • The benefit of angiotensin system inhibitors was most significant in patients treated with VEGF-targeted therapy when compared with mTOR-targeted therapy or interferon.
  • Larger prospective studies are needed before determining if these agents should be used for patients with metastatic renal cell carcinoma who do not have a medical condition warranting angiotensin system inhibitor treatment.

According to a retrospective study, the use of angiotensin system inhibitors, such as lisinopril, captopril, and losartan, improved the survival of patients with metastatic renal cell carcinoma by 9 months, compared with patients who were not receiving these types of agents. Survival was even higher in patients receiving angiotensin system inhibitors along with treatment targeting the VEGF pathway. Hypertension is a common condition in the United States, and this is the largest analysis to date evaluating the role of angiotensin system inhibitors on outcomes in patients with cancer. The findings were presented in advance of the 2014 Genitourinary Cancers Symposium in San Francisco (Abstract 437).

“Though larger prospective studies are needed, based on the results of this study, an angiotensin system inhibitor should be considered for patients with metastatic renal cell carcinoma who need an antihypertensive and do not have any contraindications that preclude their use, especially in patients receiving VEGF-targeted treatments,” said lead author Rana McKay, MD, a clinical oncology fellow at Dana-Farber Cancer Institute in Boston. “However, it is too early to determine if [these agents] should be used for patients with metastatic renal cell carcinoma who do not also have hypertension or another medical condition to warrant angiotensin system inhibitor treatment.”

Study Details

Researchers reviewed information from a clinical trials database of 4,736 patients with metastatic renal cell carcinoma treated on phase II and III clinical trials sponsored by Pfizer, Inc. Angiotensin system inhibitor users were defined as patients taking an angiotensin system inhibitor when they started treatment or within the first 30 days of treatment. The cancer treatments reflected the current treatments being used and researched for renal cell carcinoma and varied to include VEGF-targeted agents (such as sunitinib [Sutent], sorafenib [Nexavar], axitinib [Inlyta], bevacizumab [Avastin]), mTOR-targeted agents (temsirolimus [Torisel]), and interferon.

The overall survival for patients receiving angiotensin system inhibitors was 27 months, compared with 17 months for non–angiotensin system inhibitor users. In addition, the cancer was more likely to shrink in patients taking angiotensin system inhibitors.

Researchers also analyzed data from patients taking any type of antihypertensive (2,000 patients) and found that the overall survival for patients using angiotensin system inhibitors was 27 months compared to 18 months for those on other types of antihypertensive agents. When evaluating patients based on therapy type, the benefit of angiotensin system inhibitors was most significant in patients treated with VEGF-targeted therapy when compared with mTOR-targeted therapy or interferon.

About Angiotensin System Inhibitors

Angiotensin system inhibitors fall into two classes: angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). An ACE inhibitor lowers blood pressure by reducing the production of angiotensin II, which increases blood pressure, whereas ARBs block the effect of angiotensin II at the receptor. Increasingly, research has indicated that the peptide hormone angiotensin II is involved in certain steps in the process of carcinogenesis, including angiogenesis. Overall, angiotensin system inhibitors are commonly used medications in the United States. They are generally well tolerated; however, side effects include fatigue, low blood pressure, dizziness, increased potassium levels, cough, and angioedema.

For full disclosures of the study authors, view the study abstract at www.gucasym.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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