School of Public Health

Barbara Harding

Commonly used medications and survival from ovarian cancer

Background

Ovarian cancer is the 5th leading cause of cancer-related death among women in the United States. Typically diagnosed as a late stage disease, it follows an aggressive clinical course resulting in 5-year survival proportions of less than 50% for all stages and less than 30% for advanced stage disease. Current treatment for ovarian cancer consists of surgery plus chemotherapy and has largely remained unchanged in recent years, resulting in little improvement in survival. Identifying novel therapeutic approaches to combat ovarian cancer progression is vital to improving ovarian cancer survivorship. Pre-clinical and early-stage epidemiologic work has provided evidence in support of using antihypertensives and statins as possible therapies to improve survival for women with this disease. Both medication classes have been shown to reduce cancer progression and proliferation on a cellular level. Epidemiologic studies show a possible extension of survival length among antihypertensive or statin users. However, these studies have been limited by methodologic issues.

Methods

These cohort studies utilized SEER-Medicare data on women 66+ years of age diagnosed with ovarian cancer during 2007-2012 who were enrolled in Medicare parts A, B and D during the year after diagnosis. Use of the medications of interest (statins, antihypertensives [including angiotensin converting enzyme inhibitors (ACEIs), beta blockers (BBs), calcium channel blockers (CCBs) and thiazide diuretics (TDs)]) was defined as two or more fills for a given medication class during the year after diagnosis. Ovarian cancer-specific death was assessed starting one year after diagnosis. Cox proportional hazards regression models were used, adjusting for participant demographics, tumor-specific factors, and comorbidities.

Results

A total of 2,195 women who were 66+ years of age at diagnosis with ovarian cancer during 2007-2012 met inclusion criteria. Of these women, 489 (22%) used statins, 18 (33%) used a TD, 690 (31%) used an ACEI, 521 (24%) used a BB and 154 (7%) used a CCB. During a mean follow-up of 2.2 years, 796 (36%) women died from ovarian cancer. Ovarian cancer-specific mortality was found to be lower among women who used a statin (compared to non-users), adjusted hazard ratio (aHR) 0.74, 95% confidence interval (CI) 0.60-0.91. Reductions in ovarian cancer-specific mortality were also found among women who used an ACEI (aHR 0.76, 95% CI 0.63-0.92), a TD (aHR 0.82, 95%CI 0.68-0.99), or a non-selective beta-blocker (NSBB) (aHR 0.60, 95%CI 0.43-0.83), but no such association was found in women who took a selective beta-blocker (SBB) or CCB.

Conclusions

The use of statins and certain types of antihypertensive medications after ovarian cancer diagnosis is associated with reduced risks of mortality. Because statins have a relatively good safety profile coupled with findings from prior work reporting similar reductions in death among statin users, a randomized trial with statins as a therapeutic option may be warranted. Additional research of antihypertensive medication use and ovarian cancer-specific survival is warranted to confirm potential associations with certain types of antihypertensive medications.