Abstract
Introduction
The gold standard treatment for high-risk NMIBC is BCG immunotherapy. Some studies
suggested an immomodulatory effects for commonly used drugs (ie, ACE-I and ARBs).
We aimed to determine whether these drugs impact the prognosis of patients with high-risk
NMIBC treated with BCG.
Materials and Methods
Retrospective analysis on 208 patients from a single academic center with primary
high-risk NMIBC treated with transurethral resection followed by 6 weekly instillations
of BCG and up to 12 monthly maintenance instillations. ARBs or ACE-I use at the time
of treatment initiation was recorded. Inverse probability of treatment weighting (IPTW)
was used to adjust for clinical and pathological covariates. IPTW–adjusted Kaplan-Meier
curves and weighted Cox proportional hazards regression were used to compare 2-yr
failure-free (2-yr FFS), failure-free (FFS), overall recurrence-free (RFS) and progression-free
survival (PFS).
Results
A total of 68 patients were on ACE-I, and 38 on ARBs and treatment respectively. At
a median follow-up of 26 months, ACE-I treatment had no significant impact on cancer-related
outcomes. Conversely, patients treated with ARBs experienced significant improvements
in 2-yr FFS (HR 0.3; 0.1-0.9, P = .004), FFS (HR 0.4, 0.1-0.9, P = .005), and PFS (HR 0.001; < 0.001-0.001, P < .001). No significant impact was found for ARB use in RFS (HR 0.6; P = .09). Sensitivity analyses confirmed these results.
Conclusions
our findings support a potential role of the angiotensin-renin system in bladder cancer
development. We identified ARBs as potential beneficial drugs that seems to act in
synergy with BCG-immunotherapy.
Keywords
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Article info
Publication history
Published online: February 23, 2022
Accepted:
February 19,
2022
Received in revised form:
February 15,
2022
Received:
October 7,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
