Patients with thick cutaneous melanoma treated with propranolol may have a reduced risk of recurrence and mortality, according to a study published in JAMA Oncology.1
Evidence suggests that β-blockers may have anti-tumorigenic properties, and previous studies demonstrated that propranolol in particular may inhibit angiogenesis and migration of cancer cells, leading to a delay in disease progression.
For this prospective study, researchers enrolled 53 patients with confirmed stage IB to IIIA cutaneous melanoma and no evidence of metastases, of which 19 were willing to take propranolol 80 mg (PROP) as an off-label adjuvant therapy upon diagnosis, while 34 were unwilling (No-PROP). Demographic characteristics and prognostic factors among patients between the cohorts were comparable. Follow-ups were conducted every 4 months.
After a median follow-up of 3 years, 15.8% (3) of patients in the PROP cohort experienced disease progression compared with 41.2% (14) of patients in the No-PROP cohort. Patients in the PROP arm also had a disease-free survival (DFS) rate of 89% vs 64% in the No-PROP arm (P = .04).
A multivariate analysis adjusted for age, Breslow thickness, and ulceration revealed that propranolol-use was inversely related with recurrence, and reduced the recurrence risk by nearly 80% (hazard ratio [HR], 0.18; 95% CI, 0.04-0.89; P = .03).
No adverse events were reported by the PROP group. Six patients in the No-PROP arm died, 5 deaths attributed to melanoma, and 2 patients in the PROP arm died, with 1 death attributed to melanoma.
While the results of this study suggest that off-label propranolol may reduce the risk of disease progression in patients with melanoma, and the authors added that “the development of randomized placebo-controlled clinical trials is necessary to clarify a definitive role for β-blockers in protecting against the risk of progression of melanoma and to potentially identify the receptor subtype involved in the protective effect.”
- De Giorgi V, Grazzini M, Benemei S, et al. Propranolol for off-label treatment of patients with melanoma. JAMA Oncol. 2017 Sep 28. doi: 10.1001/jamaoncol.2017.2908 [Epub ahead of print]