title: Impact of renin-angiotensin system blockade on clinical outcome in glioblastoma.
abstract: OBJECTIVE
  Despite surgery, radiotherapy (RT) and temozolomide (TMZ), the prognosis of glioblastoma (GBM) patients remains dismal. Normally prescribed with the aim to lower blood pressure, angiotensin-II (Ang-II) inhibitors were reported to reduce angiogenesis and tumour growth in several tumour models including one glioma. Thus whether treatment with Ang-II inhibitors could be associated with a better clinical outcome in GBM patients was investigated.
  
  
  METHODS
  A series of 81 consecutive patients, homogeneously treated with RT and TMZ for a newly diagnosed, supratentorial GBM, were analysed. The objective of this retrospective study was to assess the impact of angiotensin-converting enzyme inhibitors (ACEIs) and Ang-II receptor 1 blockers (ARBs) on functional independence, progression-free survival (PFS) and overall survival (OS).
  
  
  RESULTS
  Amongst the 81 GBM patients analysed, 26 were already treated for high blood pressure (seven with ACEIs and 19 with ARBs). The number of patients who remained functionally independent at 6 months after RT was higher in the group of patients treated with Ang-II inhibitors compared to the other patients (85% vs. 56%, P = 0.01). In patients treated with Ang-II inhibitors, PFS was 8.7 months (vs. 7.2 months in the other patients) and OS was 16.7 months (vs. 12.9 months). The use of Ang-II inhibitors was a significant prognostic factor for both PFS (P = 0.04) and OS (P = 0.04) in multivariate analysis.
  
  
  CONCLUSIONS
  Treatment with Ang-II inhibitors in combination with RT and TMZ might improve clinical outcome in GBMs. Prospective trials are needed to test this hypothesis.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Neurologie, Bobigny, France.
authors.forename: E
authors.initials: E
authors.lastname: Januel
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Neurologie, Bobigny, France.
authors.forename: R
authors.initials: R
authors.lastname: Ursu
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Neurologie, Bobigny, France.
authors.forename: A
authors.initials: A
authors.lastname: Alkhafaji
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Neurologie, Bobigny, France.|Université Paris 13, UFR de Santé, Médecine et Biologie Humaine, Bobigny, France.
authors.forename: A
authors.initials: A
authors.lastname: Marantidou
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Neurologie, Bobigny, France.|Université Paris 13, UFR de Santé, Médecine et Biologie Humaine, Bobigny, France.
authors.forename: J
authors.initials: J
authors.lastname: Doridam
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Neurologie, Bobigny, France.
authors.forename: C
authors.initials: C
authors.lastname: Belin
authors.affiliation: Institut de Radiothérapie des Hautes Energies (IRHE), Bobigny, France.
authors.forename: C
authors.initials: C
authors.lastname: Levy-Piedbois
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Neurologie, Bobigny, France.|Université Paris 13, UFR de Santé, Médecine et Biologie Humaine, Bobigny, France.
authors.forename: A F
authors.initials: AF
authors.lastname: Carpentier
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000494:pharmacology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015173:Supratentorial Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D000077204:Temozolomide
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Karnofsky performance status; angiotensin-II; glioblastoma; radiotherapy; survival; temozolomide