The take-home message from this study is that in this large group of patients, we have found that beta-blocker intake during radiation therapy for non–small cell lung cancer (NSCLC) is associated with improved survival and reduced rates of tumor spread, even when controlling for a large number of other factors. We hypothesize that the mechanism of this benefit is blockade of the beta-adrenergic signaling pathway, which may play an important role in disease progression as demonstrated in preclinical studies.

We can’t conclude from the study data that the findings are necessarily specific to patients receiving radiation therapy. Indeed, we wanted to examine a select group of patients who were receiving definitive treatment for NSCLC, and the database we decided upon was that including patients undergoing radiation therapy. It is not unreasonable to propose that the results may be extrapolated to other modalities, such as chemotherapy or surgery. However, this hypothesis would need to be tested in the appropriate patient populations.

Currently, we would not advocate that patients with NSCLC take beta-blockers for other than their indicated uses until our findings can be validated by (1) analyses at other institutions and (2) prospective trials. Future molecular studies will help us understand whether our proposed mechanism for the observed effect of beta-blockers is correct, indicating that beta-blockers are thus indeed directly affecting the aggressiveness of this malignancy, or whether our findings are due to the activation or inhibition of another pathway. ■

Disclosure: Drs. Liao and Gomez reported no potential conflicts of interest.