Antihypertensives do not impair survival in atezolizumab-treated cancer patients

Concomitant use of antihypertensive medications, including renin–angiotensin system inhibitor (RASi), does not appear to affect survival and immune-related safety outcomes during atezolizumab therapy in patients with solid cancers, results of a study have shown.

“Antihypertensives and cancer have a complex relationship,” the authors said. “Among the antihypertensives, RASis have strong immune modulatory activities that may affect immune checkpoint inhibitor (ICI)-related outcomes in cancer patients.”

This study examined the relationship between concomitant use of RASis and other antihypertensive agents with survival and toxicity outcomes from atezolizumab through a posthoc analysis of individual patient data from seven clinical trials of lung, renal, or urothelial cancers.

Comparisons were made between users and nonusers of antihypertensive classes for overall survival, progression-free survival, and immune adverse events. The authors calculated Cox proportional hazards between groups and reported these as hazards ratio (HR) and 95 percent confidence interval (CI).

A total of 3,695 patients were included, of whom 2,539 were treated with atezolizumab and the rest with chemotherapy. Twenty-four percent of patients were on RASi at baseline.

In the atezolizumab-treated cohort, no statistically significant difference was observed in overall survival (HR, 0.92, 95 percent CI, 0.79–1.07; p=0.29), progression-free survival (HR, 0.95, 95 percent CI, 0.84­–1.08; p=0.42), or immune adverse events (odds ratio, 0.94, 95 percent CI, 0.76–1.15; p=0.55) between users and nonusers of RASi.

Other antihypertensive agents also did not appear to significantly affect survival.

“Future studies should evaluate the association between antihypertensives and other ICI as well as ICI combination interventions in clinical trials and real-world settings,” the authors said.