The concomitant use of the renin-angiotensin system inhibitors and survival outcomes of patients with pancreatic adenocarcinoma: an analysis from a tertiary center

Kuan-Yu Tseng; Chiann-Yi Hsu; Yu-Hsuan Shih; Hsin-Chen Lin; You-Cheng Li; Chieh-Lin Jerry Teng; Cheng-Wei Chou

doi:10.1177/17588359241247019

The concomitant use of the renin-angiotensin system inhibitors and survival outcomes of patients with pancreatic adenocarcinoma: an analysis from a tertiary center

Ther Adv Med Oncol. 2024 May 6:16:17588359241247019. doi: 10.1177/17588359241247019. eCollection 2024.

Authors

Kuan-Yu Tseng¹, Chiann-Yi Hsu², Yu-Hsuan Shih^{1

3

4}, Hsin-Chen Lin^{1

3}, You-Cheng Li⁵, Chieh-Lin Jerry Teng^{1

3

6

7}, Cheng-Wei Chou^{8

3

9}

Affiliations

¹ Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
² Biostatistics Task Force, Taichung Veterans General Hospital, Taichung, Taiwan.
³ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁴ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁵ Division of Hematology/Medical Oncology, Department of Medicine, Chiayi Branch, Taichung Veterans General Hospital, Taichung, Taiwan.
⁶ Department of Life Science, Tunghai University, Taichung, Taiwan.
⁷ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁸ Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan.
⁹ Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.

Abstract

Background: The limited efficacy of chemotherapy in improving survival in pancreatic ductal adenocarcinoma (PDAC) necessitates the exploration of novel strategies to overcome treatment resistance.

Objectives: This study aimed to investigate the impact of combining renin-angiotensin system (RAS) blockers with chemotherapy on survival outcomes in patients with PDAC.

Design: Patients with PDAC were enrolled in the retrospective study.

Methods: We analyzed patients with PDAC (n = 384) at our institution between 2014 and 2021. Survival outcomes, including event-free survival (EFS) and overall survival (OS), were analyzed according to the concomitant use of RAS blockers.

Results: Among the 384 patients in the study, 70 (18.2%) concomitantly received angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). Patients in the ACEI/ARB group, characterized by older age and more comorbidities, displayed a significantly superior 12-month EFS rate (22.86% versus 13.69%, p = 0.008) compared to the non-ACEI/ARB group, while OS remained similar between the groups. In the multivariate analysis, the use of ACEI/ARB was associated with better 12-month EFS (hazards ratio = 0.71, 95% confidence interval: 0.52-0.96; p = 0.024). Poor performance, advanced disease status, and higher CA19-9 levels were associated with poor survival outcomes.

Conclusion: Concomitant use of ACEIs/ARBs in patients with pancreatic cancer resulted in significantly better 12-month EFS. Age, performance status, disease status, and higher CA19-9 levels were independent predictors of survival. The combination strategy might provide better treatment outcomes in patients with PDAC.

Keywords: angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; pancreatic ductal adenocarcinoma; renin–angiotensin system; survival.