Renin-angiotensin-aldosterone system inhibitors and survival in patients with hypertension treated with immune checkpoint inhibitors.
Renin-angiotensin-aldosterone system inhibitors and survival in patients with hypertension treated with immune checkpoint inhibitors.
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DOI：
10.1016/j.ejca.2021.12.024
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发表时间：
2022-03
影响因子：
8.4
通讯作者：
Neilan, Tomas G.
中科院分区：
文献类型：
--
作者：
Drobni, Zsofia D.;Michielin, Olivier;Quinaglia, Thiago;Zlotoff, Daniel A.;Zubiri, Leyre;Gilman, Hannah K.;Supraja, Sama;Merkely, Bela;Muller, Veronika;Sullivan, Ryan J.;Reynolds, Kerry L.;Pittet, Michael J.;Jain, Rakesh K.;Neilan, Tomas G.
临床前研究表明，同时使用肾素-血管紧张素-醛固酮系统（RAAS）抑制剂可能会改善广大癌症患者的预后。关于 RAAS 抑制剂的使用与接受免疫检查点抑制剂 (ICIs) 治疗的患者的结局之间的关系的数据有限。我们对单一学术网络中接受 ICI 治疗的所有患者进行了回顾性研究。在 10,903 名患者中，有 5910 名正在服用任何抗高血压药物。在接受抗高血压治疗的患者中，有 3426 人在 ICI 治疗期间服用了 RAAS 抑制剂，2484 人服用了其他抗高血压药物。主要结果是整个队列和按癌症类型分组的总体生存率。胸部癌（34%）和黑色素瘤（16%）是最常见的癌症类型。服用 RAAS 抑制剂的患者年龄较大，男性较多，且有更多心血管危险因素。在 Cox 比例风险模型中，同时使用 RAAS 抑制剂与更好的总生存率相关（风险比 (HR)：0.92，[95% 置信区间 (CI)：0.85–0.99]，P = 0.032）。胃肠道癌症（HR：0.82，[95% CI：0.67–1.01]，P = .057）和泌尿生殖系统癌症（HR：0.81，[95% CI：0.64–1.01]，P = .067）患者的总生存率较高，但无统计学意义。在这项大型回顾性研究中，在 ICI 治疗期间同时服用 RAAS 抑制剂的高血压患者具有更好的总生存期。这种益处主要在患有胃肠道和泌尿生殖系统癌症的患者中得到体现。有必要进行前瞻性随机试验来进一步评估和明确 RAAS 抑制剂对接受 ICI 治疗的癌症患者的益处。
Preclinical studies indicate that the concurrent use of inhibitors of the renin–angiotensin–aldosterone system (RAAS) may improve outcomes in broad groups of patients with cancer. There are limited data on the association between the use of RAAS inhibitors and outcomes among patients treated with immune checkpoint inhibitors (ICIs). We performed a retrospective study of all patients treated with an ICI in a single academic network. Of 10,903 patients, 5910 were on any anti-hypertensive medication. Of those on anti-hypertensive therapy, 3426 were prescribed a RAAS inhibitor during ICI treatment, and 2484 were prescribed other anti-hypertensive medications. The primary outcome was overall survival in the entire cohort and in sub-groups by cancer types. Thoracic cancer (34%) and melanoma (16%) were the most common types of cancer. Those prescribed a RAAS inhibitor were older, more frequently male, and had more cardiovascular risk factors. In a Cox proportional hazard model, the concurrent use of RAAS inhibitors was associated with better overall survival (hazard ratio (HR):0.92, [95% Confidence Interval (CI):0.85–0.99], P = .032). Patients with gastrointestinal (HR:0.82, [95% CI: 0.67–1.01], P = .057) and genitourinary cancer (HR:0.81, [95% CI:0.64–1.01], P = .067) had a non-statistically significant better overall survival. In this large retrospective study, patients with hypertension who were concomitantly taking a RAAS inhibitor during ICI therapy had better overall survival. This benefit was primarily noted among patients with gastrointestinal and genitourinary cancers. Prospective randomized trials are warranted to further evaluate and specify the benefit of RAAS inhibitors in patients with cancer who receive ICI therapy.
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影响因子：
16.6
作者：
Robert, Caroline
通讯作者：
Robert, Caroline
影响因子：
17.1
作者：
Pinter M;Jain RK
通讯作者：
Jain RK
影响因子：
3.6
作者：
Menter AR;Carroll NM;Sakoda LC;Delate T;Hornbrook MC;Jain RK;Kushi LH;Quinn VP;Ritzwoller DP
通讯作者：
Ritzwoller DP
影响因子：
3.2
作者：
Jain RK;Skelton Iv WP;Pond GR;Naqvi M;Kim Y;Curran C;Freeman D;Nuzzo PV;Alaiwi SA;Nassar AH;Jain RK;Sonpavde G
通讯作者：
Sonpavde G
影响因子：
8.3
作者：
Unger, Thomas;Borghi, Claudio;Schutte, Aletta E.
通讯作者：
Schutte, Aletta E.