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Cancer

Session: Poster Session A

(068) Investigating the Effect of Concurrent Use of Angiotensin-Converting Enzyme Inhibitors or Receptor Blockers on Radiotherapy-related Toxicities and Treatment Outcome in Patients with Cancer: A Systematic Review and Meta-Analysis

Monday, August 26, 2024
8:00 AM – 6:00 PM CEST
Location: Convention Hall II

    Presenting Author(s)

  • Wan-Chuen Liao, DDS, MDS (she/her/hers)

    Visiting PhD Student (2023-24), University of Manchester; PhD Candidate, National Taiwan University
    Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester M13 9PL, UK; School of Dentistry, College of Medicine, National Taiwan University, Taipei 100229, Taiwan, United Kingdom

    • Co-Author(s)

  • HS

    Hala Shokr, PhD, PharmD, SFHEA, MEd, BCPS

    Lecturer
    Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, UK., United Kingdom

  • LC

    Li-Chia Chen, PhD, MSc (ClinPharm), BSc (Pharm), SFHEA

    Professor
    Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, UK., United Kingdom

Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) pharmacologically modulate radiotherapy-related toxicities and cancer-related outcomes, but literature evidence is controversial.

Objectives: This systematic review and meta-analysis evaluated the impact of concurrent ACEI/ARB use on radiation-related adverse effects and survival outcomes in patients with cancer receiving radiotherapy.

Methods: Literature was retrieved from MEDLINE, EMBASE, Web of Science, and Scopus databases from January 2000 to May 2024. Studies on adults (≥18 years) with histologically confirmed cancer receiving ACEIs or ARBs during radiotherapy were included. Radiotherapy-related side effects and clinical outcomes were analysed using odds ratios (ORs) and 95% confidence intervals (95%CIs), comparing ACEI/ARB users to non-users. Differences in median survival time, recurrence, and death rates were also calculated.

Results: Sixteen studies (14 cohort studies and two randomised trials) were included. ACEI users had a significantly reduced risk of ≥grade 2 radiation pneumonitis (OR: 0.50, 95%CI: 0.32-0.77) in lung cancer and lower ORs of proctitis (0.20, 95%CI: 0.12-0.33), haematuria (0.25, 95%CI: 0.16-0.41), and rectal bleeding (0.39, 95%CI: 0.30-0.51) in prostate cancer. ACEI/ARB users showed reduced symptomatic radiation necrosis in brain metastases and better 6-month functional independence in supratentorial glioblastoma. Among six studies reporting survival, ACEI/ARB users had longer median survival in early-stage non-small cell lung cancer and glioblastoma but shorter survival in small cell lung cancer and brain metastases. ARB users had inconsistent survival rates for lung cancer.

Conclusions: ACEI use reduces radiation pneumonitis, but evidence on other radiotherapy-related toxicities and survival outcomes varies by cancer type and severity. Further research is needed with careful control of confounders.