Lorazepam use may impact survival outcomes in patients with a range of cancers, according to a study published in Clinical Cancer Research.
Lorazepam use was associated with significantly worse outcomes in patients with pancreatic, prostate, ovarian, head and neck, colon, uterine, and breast cancer as well as melanoma, researchers found.
In this retrospective study, researchers examined benzodiazepine use in patients treated at Roswell Park Comprehensive Cancer Center in Buffalo, New York, during 2004-2020.
The researchers assessed use of 2 benzodiazepines — lorazepam and alprazolam — in this cohort and looked for associations with progression-free survival (PFS) and overall survival (OS).
The researchers first looked at 1450 patients with pancreatic cancer. In an adjusted analysis, patients who were prescribed lorazepam had significantly worse PFS than those who were not prescribed lorazepam (hazard ratio [HR], 3.83; 95% CI, 1.53-9.57; P =.004).
In contrast, pancreatic cancer patients who were prescribed alprazolam had significantly improved PFS when compared to patients who were not prescribed alprazolam (HR, 0.38; 95% CI, 0.16-0.92; P =.032).
There was no association between alprazolam or lorazepam and OS in patients with pancreatic cancer.
However, lorazepam and alprazolam were associated with OS and PFS for patients with other cancers. The researchers evaluated patients with brain (n=664), breast (n=2332), uterine (n=630), head and neck (n=803), renal (n=588), ovarian (n=570), colon (n=780), and prostate (n=821) cancer as well as melanoma/invasive nevi (n=700).
In adjusted analyses, lorazepam use was associated with significantly worse PFS in patients with:
- Prostate cancer (HR, 1.899; 95% CI, 1.433-2.517; P <.0001 )
- Ovarian cancer (HR, 1.464; 95% CI, 1.174-1.826; P =.0007)
- Melanoma/invasive nevi (HR, 2.195; 95% CI, 1.699-2.835; P <.0001)
- Head and neck cancer (HR, 1.635; 95% CI, 1.313-2.036; P <.0001)
- Colon cancer (HR, 1.782; 95% CI, 1.457-2.179; P <.0001)
- Uterine cancer (HR, 1.433; 95% CI, 1.069-1.921; P =.0160)
- Breast cancer (HR, 1.345; 95% CI, 1.138-1.591; P =.0005).
Lorazepam use was also associated with significantly worse OS in patients with:
- Prostate cancer (HR, 2.160; 95% CI, 1.589-2.936; P <.0001)
- Ovarian cancer (HR, 1.521; 95% CI, 1.212-1.907; P =.0003)
- Melanoma/invasive nevi (HR, 1.978; 95% CI, 1.519-2.576; P <.0001)
- Head and neck cancer (HR, 1.629; 95% CI, 1.304-2.035; P <.0001)
- Colon cancer (HR, 1.620; 95% CI, 1.317-1.993; P <.0001)
- Uterine cancer (HR, 1.376; 95% CI, 1.021-1.854; P =.0362)
- Breast cancer (HR, 1.248; 95% CI, 1.050, 1.484; P =.0119).
However, lorazepam was associated with improved OS in patients with brain cancer (HR, 0.779; 95% CI, 0.616-0.986 P =.0381).
For most cancers, alprazolam was not associated with significant differences in outcomes. However, patients with breast cancer had significantly worse OS (HR, 1.867; 95% CI, 1.528-2.281; P <.0001) and PFS (HR, 1.850; 95% CI, 1.523-2.248; P <.0001) if they were prescribed alprazolam.
Patients with uterine cancer had worse PFS if they were prescribed alprazolam (HR, 1.668; 95% CI, 1.051-2.646; P =.0298), and patients with prostate cancer had worse OS if they were prescribed alprazolam (HR, 1.464; 95% CI, 1.038-2.064; P =.0298).
“Due to the frequency that BZDs [benzodiazepines] are prescribed, this is an issue that could affect a large percentage of cancer patients,” the researchers concluded. “Performing prospective clinical trials and additional experimental studies to determine whether BZDs affect therapeutic efficacy is vital.”
Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Cornwell AC, Tisdale AA, Venkat S, et al. Lorazepam stimulates IL6 production and is associated with poor survival outcomes in pancreatic cancer. Clin Cancer Res. Published online August 17, 2023. doi:10.1158/1078-0432.CCR-23-0547