A recent review of medical records as published in the Journal of Clinical Oncology showed that women with cardiovascular conditions who take nonselective beta-blockers (NSBB) such as propranolol at the time of ovarian cancer surgery can result in greater two-year survival.
Preclinical studies have shown that the stimulation of beta-adrenergic receptors can increase factors associated with angiogenesis, the forming of new blood vessels. Ovarian tumors express beta-2 adrenergic receptors, and in vitro studies on ovarian cells confirmed that exposure to propranolol can induce apoptosis and protective autophagy.
Adrenergic stress caused before, during, and after resection of tumors can activate inflammatory responses that promote tumor growth and can increase metastasis. In animal models, surgical stress increased tumor activity but was reduced by the perioperative administration of propranolol. These prior studies warranted extra research, leading to a study examining the use of beta blockers during ovarian cancer and its correlation with survival.
The study took place in Australia and involved a population-based cohort of 3844 women, age 50 or older, who had a history of cardiovascular conditions and had undergone surgery for epithelial ovarian cancer (EOC). The women were studied for survival outcomes, post-surgery. At the time of surgery, 14.5% of women were prescribed a selective beta-blocker (SBB) and 1.7% of women were prescribed a nonselective beta-blocker (NSBB). About 85% of patients in the test group that received SBBs had hypertension, 18% had heart failure, 95% had ischemic heart disease, and 15% had angina. In the NSBB test group, 73% of patients had hypertensions and 12% had arrythmias or heart failure.
While no association was found between the use of SBBs and a survival advantage, women who received NSBBs at surgery had a survival proportion of 80% when followed up two years after surgery. Patients who received SBBs had worse two-year all-cause mortality rates and cancer-specific mortality when compared to patients who did not receive beta-blockers.
The patients who received NSBBs also had better overall survival and cause-specific survival when compared to patients who did not receive beta-blockers. Long-term trials with larger populations are still needed to confirm the findings of this study. The authors of the study noted that “the repurposing of safe and inexpensive drugs, like propranolol, is hindered by the lack of immediate financial incentive for private industry to conduct a large randomized clinical trial, so a joint collaborative approach between governments, researchers, and funders will likely be required.”
Studies evaluating the use of NSBBs alongside other forms of cancer are underway, including its effects on breast cancer, melanoma, and pancreatic cancer. NSBBs have also been shown to potentially reverse the adverse effects of beta-2 adrenergic stress in radiation therapy. For women with cardiovascular conditions over the age of 50, the use of NSBBs have been shown to offer a prolonged survival advantage post-EOC surgery.
Perioperative Beta-Blocker Supply and Survival in Women With Epithelial Ovarian Cancer and a History of Cardiovascular Conditions
Nonselective Beta-Blockers May Improve Outcomes in Ovarian Cancer