Cumulative-use analyses suggest that non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme inhibitors (ACEis), and selective serotonin reuptake inhibitors (SSRIs) improve survival rates among patients with kidney cancer, according to a study published in the International Journal of Cancer.1
Some lab-based experiments and murine models suggest that NSAIDs, ACEis, and SSRIs have anti-tumor or anti–cancer cell proliferation effects. Pharmacoepidemiology studies have, however, produced mixed results, though different data analysis methods may explain these discrepancies.
For this study, the authors intended “to evaluate the association between use of commonly-prescribed medications with potential anti-neoplastic effects and survival in patients with incident kidney cancer…[and]…to compare different methods of classifying exposure to better understand the biases that may arise from pharmacoepidemiology studies.”
The study took place over 16 years, during which data from 9214 patients with kidney cancer were analyzed. All patients were at least 65 years old; at analysis, 5022 patients had died, among which 2106 deaths were attributed to cancer.
While discrepancies were found between the current-use analysis and the cumulative-use analysis, the authors argued that cumulative-use analyses permit “evaluation of a dose-response relationship, supporting causality for chemoprevention.”
The cumulative-use analysis suggested that NSAIDs, ACEis, and SSRIs improve disease-specific outcomes among patients with kidney cancer, and further that NSAIDs improve overall survival. The duration of use also correlated with the degree of survival benefit: ACEi use for 6-12 months conferred a disease-specific survival hazard ratio (HR) of 0.96, while use for 54-60 months conferred an HR of 0.77.
Cumulative use of SSRIs for 54-60 months carried an HR for disease-specific survival of 0.31. Cumulative use of NSAIDs for 54-60 months carried an HR for disease-specific survival of 0.38 and an HR for overall survival of 0.65.
While these marked survival improvements were dependent on the method of analysis, the authors concluded both that cumulative-use analyses are the optimal method for classifying drug exposure and that NSAIDs, ACEis, and SSRIs “may have a role in improving survival outcomes in patients with kidney cancer.”
- Nayan M, Juurlink DN, Austin PC, et al. Medication use and kidney cancer survival: A population-based study. Int J Cancer. 2017 Dec 11. doi: 10.1002/ijc.31204 [Epub ahead of print]