title: Beta-blocker use is associated with improved relapse-free survival in patients with triple-negative breast cancer.
abstract: OBJECTIVE
  To examine the association between beta-blocker (BB) intake, pathologic complete response (pCR) rates, and survival outcomes in patients with breast cancer treated with neoadjuvant chemotherapy.
  
  
  METHODS
  We retrospectively reviewed 1,413 patients with breast cancer who received neoadjuvant chemotherapy between 1995 and 2007. Patients taking BBs at the start of neoadjuvant therapy were compared with patients with no BB intake. Rates of pCR between the groups were compared using a χ² test. Cox proportional hazards models were fitted to determine the association between BB intake, relapse-free survival (RFS), and overall survival (OS).
  
  
  RESULTS
  Patients who used BBs (n = 102) were compared with patients (n = 1,311) who did not. Patients receiving BBs tended to be older and obese (P < .001). The proportion of pCR was not significantly different between the groups (P = .48). After adjustment for age, race, stage, grade, receptor status, lymphovascular invasion, body mass index, diabetes, hypertension, and angiotensin-converting enzyme inhibitor use, BB intake was associated with a significantly better RFS (hazard ratio [HR], 0.52; 95% CI, 0.31 to 0.88) but not OS (P = .09). Among patients with triple-negative breast cancer (TNBC; n = 377), BB intake was associated with improved RFS (HR, 0.30; 95% CI, 0.10 to 0.87;P = .027) but not OS (HR, 0.35; 95% CI, 0.12 to 1.00;P = .05).
  
  
  CONCLUSIONS
  In this study, BB intake was associated with improved RFS in all patients with breast cancer and in patients with TNBC. Additional studies evaluating the potential benefits of beta-adrenergic blockade on breast cancer recurrence with a focus on TNBC are warranted.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA. amelhem@mdanderson.org
authors.forename: Amal
authors.initials: A
authors.lastname: Melhem-Bertrandt
authors.forename: Mariana
authors.initials: M
authors.lastname: Chavez-Macgregor
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.forename: Erika N
authors.initials: EN
authors.lastname: Brown
authors.forename: Richard T
authors.initials: RT
authors.lastname: Lee
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sood
authors.forename: Suzanne D
authors.initials: SD
authors.lastname: Conzen
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Hortobagyi
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Gonzalez-Angulo
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D048909:Diabetes Complications / Q000188:drug therapy; D003920:Diabetes Mellitus / Q000188:drug therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000096:biosynthesis; D011960:Receptors, Estrogen / Q000096:biosynthesis; D011980:Receptors, Progesterone / Q000096:biosynthesis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human