Role of common medications and nutritional supplements in non-small cell lung cancer patients
Non-small cell lung cancer (NSCLC) can lead to a wasting syndrome called cancer cachexia. Cachexia has been defined as a body weight loss of ≥5% in six months or less, in the presence of underlying disease. Some common medications that have recently been identified as possible disruptors to this process include beta blockers (BB), angiotensin converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB). Oral nutritional supplements add macronutrients to a patient's diet, but their role has not been evaluated in the development or prevention of cancer cachexia. This retrospective, chart review study at the Veterans Affairs hospital in Houston, Texas hypothesized that exposure to ACE-I/ARB, BB, ACE-I/ARB + BB or nutritional supplements would improve the following outcomes in a sample of 440 male NSCLC patients: survival, weight and body composition change percentages (measured by weight and computed tomography images of fat and muscle at four locations over two time points), albumin changes from diagnosis to six months post-diagnosis, and development of cachexia. Patient exposure to drugs or nutritional supplements was designated if the patient took them for ≥6 months in the first year post-diagnosis. Nutritional supplements showed no relationships with any of the outcomes; however, a small number of subjects (n=23, 5% of subjects) were exposed. Results of the drug group exposures showed that ACE-I/ARB or both ACE-I/ARB + BB improved survival (p<0.0005, M=753 and 797 days respectively) over unexposed patients (M=468 days) or those exposed to BB alone (M=438 days), even when controlling for cancer stage ( p<0.0005). No other significant results were found when exposed patients were compared to unexposed patients. Therefore, the decreased mortality is not related to changes in body weight, body composition, development of cachexia or albumin. Other ACE-I/ARB mechanisms for increasing survival (such as slowing tumor progression or attenuating inflammation) should be investigated in the future.