title: Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes.
abstract: BACKGROUND
  ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may have anti-tumor properties. We investigated whether the use of ACEI/ARBs affects the clinical outcomes of primary breast cancer patients receiving taxane and anthracycline-based neoadjuvant chemotherapy.
  
  
  METHODS
  We included 1449 patients with diagnosis of invasive primary breast cancer diagnosed at the MD Anderson Cancer Center between 1995 and 2007 who underwent neoadjuvant chemotherapy. Of them, 160 (11%) patients were identified by review of their medical record, as ACEI/ARBs users. We compared pathologic complete response (pCR) rates, relapse-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) between ACEI/ARB users and non-users. Descriptive statistics and Cox proportional hazards model were used in the analyses.
  
  
  RESULTS
  There was no difference in the pCR rates between ACEI/ARB users and non-users (16% vs 18.1%, p-=0.50). After adjustment for important demographic and clinical characteristics, no significant differences between ACEI/ARB users and nonusers were observed in RFS (HR=0.81; 95% CI=0.54-1.21), DSS (HR=0.83; 95% CI=0.52-1.31), or OS (HR=0.91; 95% CI =0.61-1.37). In a subgroup analysis, the 5-year RFS was 82% in ARB only users versus 71% in ACEI/ARB non-users (P=0.03). In the multivariable analysis, ARB use was also associated with a decreased risk of recurrence (HR=0.35; 95% CI=0.14-0.86). No statistically significant differences in DSS or OS were seen.
  
  
  CONCLUSIONS
  No differences in pCR and survival outcomes were seen between ACEI/ARB users and non-users among breast cancer patients receiving neoadjuvant chemotherapy. ARB use may be associated with improved RFS. Further research is needed to validate this finding.
authors: 1. Division of Cancer Medicine.
authors: Young Kwang
authors: YK
authors: Chae
authors: Erika N
authors: EN
authors: Brown
authors: Xiudong
authors: X
authors: Lei
authors: Amal
authors: A
authors: Melhem-Bertrandt
authors: Sharon H
authors: SH
authors: Giordano
authors: Jennifer K
authors: JK
authors: Litton
authors: Gabriel N
authors: GN
authors: Hortobagyi
authors: Ana M
authors: AM
authors: Gonzalez-Angulo
authors: Mariana
authors: M
authors: Chavez-Macgregor
keywords: ACE inhibitor; ARB; breast cancer; neoadjuvant chemotherapy
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