Beta Blockers Plus Checkpoint Inhibitor Improve Cancer Control

The study was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key Takeaway

  • The use of beta blockers with immune checkpoint blockers is associated with better cancer control among patients with solid tumors, especially those with urothelial carcinoma, who demonstrated improved overall survival as well.

Why This Matters

  • The findings in this retrospective analysis bolster previous reports of the synergistic effect of beta blockers and immune checkpoint inhibitors for patients with melanoma and non–small cell lung cancer (NSCLC).

  • The evidence is strong enough to warrant prospective trials.

Study Design

  • The investigators reviewed cases of 339 patients who were taking immune checkpoint blockers (ICBs) for advanced solid tumors.

  • They then compared outcomes among the 109 patients who were also taking beta blockers with the outcomes of 230 patients who were not.

  • Overall, 77% of those who received beta blockers were taking a β1-selective drug, while the rest were taking nonselective beta blockers.

  • Of the patients in the analysis, 24% had NSCLC, 21.5% had melanoma, 15% had urothelial cancer, and 15% hepatocellular carcinoma. The rest had other types of tumors.

Key Results

  • The rate of disease control was higher among patients who received beta blockers than it was for the patients who did not take them (62% vs 39%). Disease control was defined as stable, partial, or complete response on imaging 12 weeks after the start of ICB therapy.

  • When adjusted for beta blocker treatment status, age group, Eastern Cooperative Oncology Group status, line of therapy, cardiovascular/cerebrovascular disease, and diabetes/hyperlipidemia, use of beta blockers was associated with a statistically higher likelihood of disease control (odds ratio, 2.79; P < .001).

  • While there was no significant overall survival benefit across the entire cohort, overall survival was improved for patients who received selective beta blockers compared to those who received nonselective beta blockers or those who did not receive beta blockers (hazard ratio [HR], 0.68; P = .05).

  • Patients with urothelial cancer who took beta blockers also demonstrated significantly better overall survival (HR, 0.24; P = .0031).

  • Duration of ICB therapy was longer for patients who received beta blockers for melanoma, NSCLC, and urothelial carcinoma.

Limitations

  • The individual tumor cohorts were small, and the study was possibly underpowered.

  • The investigators did not control for the use of chemotherapy with immunotherapy, which might have confounded the results.

Disclosures

  • There was no outside funding for the work. The investigators have disclosed no relevant financial relationships.

This is a summary of a preprint research study, “Effect of Concurrent Beta-blocker Use in Patients Receiving Immune Checkpoint Inhibitors for Advanced Solid Tumors,” led by George Mellgard of the Icahn School of Medicine at Mount Sinai, New York City. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: [email protected]

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