Pancreatic cancer is one of the most aggressive cancers. The 5-year survival rate of pancreatic cancer patients in the United States is 11%, which is truly the king of cancer. At present, surgical resection is still the only treatment option to significantly prolong the survival of patients with pancreatic cancer. However, only 10-20% of patients are suitable for resection. In the past two decades, scientists have conducted a lot of research on the treatment of pancreatic cancer and its unresectable patients, and the overall survival rate has only slightly improved.
Previously, numerous preclinical data supported that angiotensin receptor antagonists (ARB) and angiotensin converting enzyme inhibitors (ACEI) have multiple effects on the metabolism and cell cycle mechanism of pancreatic cancer cells, especially ARB. However, to date, no large cohort study has evaluated the association of ARB and ACEI with mortality in the general population and in patients with pancreatic cancer.
A study published in the journal BMC cancer evaluated whether the use of ARB or ACEI after the diagnosis of pancreatic cancer was associated with patient survival. The study found that people who took antihypertensive drugs lived longer than those who did not.
ARB can reduce blood pressure steadily for a long time. It also has the functions of reducing urinary protein, delaying renal damage and improving myocardial function. It plays an important role in the treatment of hypertension. ARB drugs have definite antihypertensive effect, definite protective effect on target organs, and no adverse effect on glucose and lipid metabolism; It is suitable for grade 1-2 hypertension, especially for patients with hypertension complicated with left ventricular hypertrophy, heart failure, prevention of atrial fibrillation, diabetes nephropathy, metabolic syndrome, microalbuminuria and proteinuria.
There are many kinds of ARB drugs, and they are often named after "artan". Currently, artan drugs include valsartan, losartan, irbesartan, telmisartan, candesartan, olmesartan and alisartan.
ACEI exerts its antihypertensive effect by inhibiting angiotensin converting enzyme, blocking the production of renin angiotensin Ⅱ and inhibiting the degradation of kallikrein. At present, the commonly used drugs of ACEI include captopril, enalapril, benazepril, midalapril and cilazapril.
In this study, the research team collected a database of 3.7 million people from northern Italy from 2003 to 2011, including 8158 patients with pancreatic cancer, of whom 20% underwent pancreatectomy, 36% were diagnosed with metastatic disease, and nearly half of pancreatic cancer patients also took ACEI or ARB to control hypertension. As of December 2012, 7027 people (86%) had died.
The results showed that, based on the Cox model adjusted for potential confounding factors, compared with cancer patients who did not take ACEI or ARB, the risk of death of patients with pancreatic cancer who took ARB was reduced by 20%, and the risk of death of patients with pancreatic cancer who took ACEI was reduced by 13%.
Risk of death in patients with pancreatic cancer after taking ACEI and ARB drugs
Notably, the reduced risk of death associated with ACEI was no longer evident after three-year survival, while the reduced risk of death associated with ARB remained. More importantly, if patients with pancreatic cancer receive surgical treatment, the risk of death after taking ARB is greater.
The researcher said, "we do not see a good prognosis for patients with pancreatic cancer after chemotherapy. ACEI or ARB drugs are cheap, have low side effects, can be widely used, and can improve the survival rate of patients with pancreatic cancer." Despite this conclusion, the researchers and other experts cautioned that "it is too early to recommend that all patients with pancreatic cancer start taking these drugs in order to gain a survival advantage. We still need more research to understand the underlying mechanism."
The researchers suggest that patients with pancreatic cancer urgently need more effective treatments. We need to develop more reliable treatment methods, such as how long pancreatic cancer patients can survive on average compared with those who do not take ACEI or ARB drugs. It is suggested that more studies are needed before patients with pancreatic cancer start taking antihypertensive drugs.
Original source
Scott W. Keith et al, Angiotensin blockade therapy and survival in pancreatic cancer: a population study, BMC Cancer (2022). DOI: 10.1186/s12885-022-09200-4
Source:
https://www.medsci.cn/article/show_article.do?id=44b7e367908b
