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

Articles in Press

Document Type : Original Article(s)

Authors

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

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

Main Subjects

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination, and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.30476/mejc.2024.102063.2071

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Middle East Journal of Cancer

Articles in Press, Accepted Manuscript
Available Online from 11 August 2024
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