2nd Place - Research

Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers May Reduce Breast Cancer Recurrence.
Primary Author: Young Kwang Chae
Additional Authors: Matias E. Velsacchi, Jongoh Kim, Ajit Desai
Institution: Albert Einstein Medical Center

Learning objective 1: to learn about the novel anti-timor effect of angiotensin converting enzyme inhibitors and ARBs
Learning objective 2: to learn about cancer recurrence patterns in stage 2 and 3 breast cancer patients

Background: There have been epidemiologic and biochemical findings alluding to the role of angiotensin converting enzyme inhibitors(ACEIs) and angiotensin receptor blockers(ARBs) in reducing the risk of developing cancer. Recent molecular and biochemical studies are reporting their anti-angiogenesis effects. To date, there exists no study that reported any relationship between their use and the risk of cancer recurrence.

Methods: We reviewed the medical records of female patients diagnosed with stage II/III breast cancer in Albert Einstein Medical Center between 1999 and 2005 and later reached no evident disease(NED) stage after curative therapy. Follow up period was from 1999 to 2008 with mean and maximum being 4.4 years and 9.8 years, respectively. ACEI/ARB user was defined as patients taking the medication in NED stage for at least 6 months. Multivariate analyses were performed using logistic regression and Cox proportional hazard model.

Results: Of 707 cancer patients and of 335 cancer patients with hypertension, 164, representing 23.3% of total and 49.0% of those with hypertension were prescribed ACEI/ARB. ACEI/ARB use was associated with older age(P < 0.001), postmenopausal status(P < 0.001), and diabetes(P < 0.01). Fourteen percent(23/164) of ACEI/ARB users developed cancer recurrence, while 23.3%(125/541) of nonusers developed a recurrence(odds ratio[OR], 0.54; 95% confidence interval[CI], 0.33-0.97; P=0.01). Kaplan-Meier survival analysis revealed that ACEI/ARB use was related to disease-free survival benefit(log-rank test P < 0.01). Five year disease-free survival for ACEI/ARB users was 0.85 compared with 0.76 for nonusers(P < 0.01). Adjusting for statistically significant variables above, ACEI/ARB use was associated with reduced risk of developing recurrence not only in all breast cancer patients(adjusted hazard ratio[AHR], 0.56; 95% CI; 0.35-0.88; P=0.01) but also when they were compared to a subset of the nonusers who had hypertension (AHR, 0.41; 0.23-0.80; P < 0.01). While ACEI/ARB use was not associated with reduced mortality in all breast cancer patients(AHR, 1.01; 95% CI: 0.61-1.65; P=0.36; log-rank test P=0.52), it was when compared to the subset of patients with hypertension(AHR, 0.43; 95% CI, 0.25-0.68; P < 0.01; log-rank test P < 0.01).

Discussion: The use of ACEI/ARB is related to reduced risk of developing recurrence in patients with breast cancer. This result provides the first clinical evidence that antagonizing angiotensin system is inversely associated with tumor recurrence.


Page updated: 10/29/09

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