Middle East Journal of Cancer

Efficacy of Combined Bevacizumab and Angiotensin-Converting Enzyme Inhibitors or Angiotensin II type 1 Receptor Blockers in Metastatic Colorectal Cancer Patients

Document Type : Original Article(s)

Authors

Ali Kaan Güren 1
Nargiz Majidova 1
İclal Çakır 2
Nadiye Sever 1
Erkam Kocaaslan 1
Pınar Erel 1
Yeşim Ağyol 1
Abdussamed Çelebi 1
Rukiye Arıkan 1
Selver Işık 1
Murat Sarı 1
Özlem Ercelep 1
İbrahim Vedat Bayoğlu 1
Osman Köstek 1

1 Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey

2 Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey

https://doi.org/10.30476/mejc.2024.102063.2071
Abstract
Background: Bevacizumab, used in the treatment of metastatic colorectal cancer (mCRC), has an angiogenesis inhibitory effect. Angiotensin converting enzyme inhibitors (ACEi) and angiotensin II type 1 receptor blockers (ARBs) used in the treatment of arterial hypertension demonstrate antitumoural effects through different pathways. In our study, we aimed to investigate whether ACEi or ARB has a synergistic effect on survival in patients receiving bevacizumab treatment.
Method: A total of 208 patients receiving Bevacizumab for mCRC were included in this retrospective study. We divided the patients into two groups as Renin Angiotensin System inhibitors (RASi) users and non-users. We compared the progressin-free survival (PFS) and overall survival (OS) times between the 2 groups. Kaplan-Meier and Cox regression analyses were used for statistical analyses.
Results: In this study, 53 patients with RASIs and 155 without RASIs were included. The RASIs group had a median PFS of 8.66 months, while the non-RASIs group had a median of 6.67 months (P = 0.034; P < 0.05). The RASIs group had a median OS of 24.86 months, while the non-RASIs group had a 18.71 months (P = 0.039; P < 0.05). In the RASIs group, multivariate analysis showed PFS [hazard ratio (HR): 1.425 (95% confidence interval (CI): 1.037-1.959), P = 0.029] and OS [HR: 1.371 (95% CI: 1.001-1.897), P = 0.044].
Conclusion: Bevacizumab in combination with ACEi or ARBs prolongs PFS and OS in patients with mCRC. Prioritising ACEi and ARBs in patients with mCRC and arterial hypertension provides a survival advantage. These findings should be supported through further studies involving larger patient populations and addressing other factors that may affect prognosis.

Highlights

Ali Kaan Güren (Google Scholar)

Keywords

Colorectal neoplasms
Bevacizumab
Angiotensin-converting enzyme inhibitors
Angiotensin II type 1 receptor blockers
Subjects

How to cite this article:

Güren AK, Majidova N, Çakır İ, Sever N, Kocaaslan E, Erel P, et al. Efficacy of combined Bevacizumab and angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers in metastatic colorectal cancer patients. Middle East J Cancer. 2025;16(2):162-9. doi: 10.30476/mejc.2024.102063.2071.

 

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