Medications established for other health conditions may be beneficial against cancer
Several existing drugs, including those that treat high blood pressure and high blood sugar, are being studied alongside other treatments in cancer patients to see if they offer a survival benefit, although more research is needed. to determine if this is a possibility.
There may be some overlap on what cardiometabolic drugs — those that focus on dysfunctions related to heart disease, diabetes, and chronic kidney disease — treat and certain aspects of cancer. For example, drugs that control blood pressure, such as angiotensin converting enzyme (ACE) inhibitors, can alter a patient’s vascular system, which can lead to improved therapeutic responses. Additionally, some common risk factors for breast cancer can also increase the risk of heart disease, such as higher insulin levels and higher inflammation.
As things stand, some experts would frown on the use of these cardiometabolic drugs for potential cancer survival benefit.
“I would not recommend metformin or aspirin for the purpose of treating breast cancer based on large-scale trials that have tested the impact of these drugs on cancer recurrence and survival in women” , said Dr. Jennifer A. Ligibel, director of the Leonard P. Zakim Center for Integrative Therapies and Healthy Living at the Dana-Farber Cancer Institute and associate professor of medicine at Harvard Medical School in Boston, in an interview with TO CURE ®.
Despite this recent bump in the road in the search for cardiometabolic drugs in cancer patients, other experts remain hopeful.
“It is safe to say that (cardiometabolic drugs have) the potential to benefit all types and stages of cancer, but in the clinical setting, each of these tumor types and disease stages will need to be studied to determine if this potential can be realized,” said Dr. Zachary Morris, associate professor and vice chair of the department of human oncology at the University of Wisconsin School of Medicine and Public Health at Madison. TO CURE®.
“It will take some time to understand whether and how best to take these agents in conjunction with other cancer therapies. They may work for some conditions or with some other treatments better than others, but that’s yet to be determined by clinical research.
POTENTIAL BENEFITS IN CERTAIN TYPES OF CANCER
Morris and colleagues have conducted research in this area and their findings include those of a study published in Cancer in 2016. The authors assessed increased tumor response to neoadjuvant radiation therapy in patients with rectal cancer who were taking ACE inhibitors or angiotensin receptor blockers, both of which have traditionally been used to lower blood pressure in patients with hypertension. The results of this particular study demonstrated that accidental use of these two blood pressure-lowering drugs was correlated with a three-fold increase in the complete response rate (the disappearance of all signs of cancer in response to treatment).
“Some of our drugs that might impact the vasculature or blood pressure, for example, might have effects on the blood perfusion of the tumor microenvironment,” Morris said. “It’s not that the drugs themselves kill cancer cells directly, but they can help us give other things like chemotherapy that might then kill that tumor better, or, in the case of radiation, we need oxygen in the tumor to kill tumor cells more effectively with radiation Simply improving blood flow to a tumor during the time radiation therapy is given can impact the effectiveness of radiation therapy in this local environment.
Other studies have been conducted, including one whose results were published in Cancer Medicine in 2021. The results of this study demonstrated that drugs for hypertension can improve the survival of patients with colorectal cancer.
A number of older studies have suggested that metformin in particular may help prevent breast cancer and that women who took metformin after a cancer diagnosis may have a lower risk of dying from breast cancer. breast. These studies led to the development of a large trial called MA-32 which tested whether adding metformin as part of breast cancer treatment would reduce the risk of cancer recurring after initial treatment.
Early results from the MA-32 trial, which included more than 3,000 women, showed that patients who received metformin during treatment had improved weight and metabolic factors compared to those who received a placebo. However, final study results released earlier this year showed that metformin did not prevent or stop the spread of breast cancer.
“It was very disappointing,” Ligibel said. “We certainly hoped that metformin would be a useful treatment for breast cancer, but unfortunately this study showed that metformin was not useful as a treatment for breast cancer. This is why it is so important to conduct clinical trials. Sometimes treatments are not helpful even when there is excellent preliminary information that this (drug) may be making a difference.
IT’S TIME TO REGROUP
Based on the negative results of recent studies in this area, Ligibel said: “We are in a consolidation phase for this concept. She added that the benefit seen in earlier metformin studies may be due to the types of studies that
had been conducted before.
For example, some have been observational in nature, meaning
that researchers asked a large group of cancer patients about the medications they take. Although the researchers are able to observe any pattern, the study does not take into consideration whether other factors are playing an effect, such as why the patients are taking a particular drug or what other health problems they might have. Additionally, preliminary studies are often performed in animal models, and while these models may be helpful in the trajectory of research, dosages may be different in animals versus humans.
Further research is needed to determine whether cardiometabolic drugs may have benefits in other types of cancer, despite the disappointing results in breast cancer. Some areas of interest include which types of cancer may benefit from this diet versus others; whether patients get the benefit immediately or whether the drug needs to be taken for a period of time before starting cancer treatment; and whether statins (which lower cholesterol) and aspirin (often used to prevent blood clots) have a similar benefit in cancer patients.
Morris mentioned that patients can play a huge role in the studies needed in this area.
“We truly appreciate and respect patients when they contribute
to clinical trials,” Morris said. “It’s such a selfless gesture because
we don’t know if (a trial) will benefit any particular patient, but we do know that it will benefit our understanding of cancer and disease in general. …If patients are interested…(and) if it seems like the right thing for them,…participating in clinical trials is a really thoughtful gesture on (their) behalf.
Ligibel also advised patients to take care of themselves with physical activity, healthy eating and maintaining a healthy weight.
“So far the drugs haven’t really shown that much benefit, but there’s a huge benefit to living a healthy lifestyle,” she said, “(and,) if you’re suffering diabetes or high blood pressure, make sure that you take care of these conditions…. It is extremely important if you have cancer or do not have cancer, to make sure that your blood pressure is well controlled , that your diabetes is well controlled.We know that managing these conditions is absolutely life prolonging and very important for people’s overall health.
For more information on cancer updates, research and education, be sure to sign up for CURE® newsletters here.