Angiotensin converting enzyme inhibitors and angiotensin receptor blockers and ovarian cancer survival: the Ovarian cancer Prognosis And Lifestyle (OPAL) study.

OBJECTIVE

There is some evidence that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) might improve cancer survival, but reliable data for ovarian cancer are scarce. We evaluated this using data from the prospective Ovarian cancer Prognosis and Lifestyle (OPAL) study.

MATERIALS AND

METHODS

We included 954 Australian women diagnosed between 2012 and 2015 and considered pre-diagnosis and post-diagnosis medication use and ovarian cancer survival. We used Cox proportional hazard models to estimate adjusted hazard ratios (aHR) and 95 % confidence intervals (CI) for all medication users and monotherapy users (those who used a single medication). We applied inverse probability of treatment weighting to further reduce confounding and estimated restricted mean survival time at 7 years (end of study).

RESULTS

We observed a modest association between ARB use before or after diagnosis and progression-free and ovarian cancer-specific survival. Estimates were further from the null for post-diagnosis use ARB monotherapy, and when weighted for users (pre-diagnosis use aHR=0.71, 95 %CI: 0.51-0.98; post-diagnosis use aHR=0.60, 0.36-1.01 for ovarian cancer-specific survival). If real, this would translate to a 6-month increase in mean survival for ARB monotherapy. The associations were attenuated in models weighted for all women. There was little evidence of an association with ACE inhibitors.

CONCLUSIONS

Further evaluation in larger cohorts is required to confirm these findings. If the observed associations are confirmed, ARBs may warrant consideration as a first line hypertension treatment for women with ovarian cancer.