medwireNews: Statins appear to be associated with improved outcomes among patients with metastatic renal cell carcinoma (RCC) taking nivolumab, indicates a chart review.
Patients who did versus did not take concomitant statins had significantly better overall survival (OS) and progression-free survival (PFS) as well as a significantly higher clinical benefit rate, report Matteo Santoni, from Macerata Hospital in Italy, and co-researchers.
But they stress that the results “should be interpreted with caution” and add: “Prospective clinical trials investigating the role of statins in patients with [metastatic] RCC treated by immunotherapy or immuno-oncology combinations are thus needed.”
The investigators collated data on 219 patients with metastatic RCC (69% men) who received nivolumab in the second- (71%) or third-line (29%) setting between January 2016 and September 2021 at one of 10 institutions in Italy, Spain, and the USA.
Just over a quarter (27%) were considered statin users, as they had been prescribed the drugs for at least 30 days and were taking them at the time of nivolumab initiation and throughout the course of therapy.
As reported in the European Journal of Cancer, median OS was significantly longer among statin users than nonusers, at 34.4 versus 18.6 months, and this was also the case for PFS, at a median of 11.7 versus 4.6 months.
And a significantly greater proportion of statin-treated patients achieved clinical benefit – defined as a complete or partial response or stable disease – than their unexposed counterparts, with respective rates of 71% and 54%.
Noting that the statins group had a significantly higher proportion of patients aged at least 70 years, the authors stratified the study population by age, finding that the survival benefit of statins was consistent in both older and younger patients.
For instance, among participants aged 70 years or older, median OS was 21.4 months for statin users and 10.1 months for nonusers, while the corresponding durations were 34.4 and 21.4 months for those younger than 70 years. The between-group differences were statistically significant in both age groups, and the PFS findings were similar.
Finally, multivariate analysis adjusting for factors such as age, sex, histology, number of metastatic sites, and IMDC prognostic group revealed a significant association between statin use and improved OS, with a hazard ratio (HR) for death of 0.62.
Statin use was similarly significantly associated with improved PFS, with an HR for disease progression or death of 0.56.
Discussing the findings, Santoni and colleagues say that “[s]ince the early 1990s, it has been evident that statins could play some role in treating patients with solid tumours, but the exact mechanisms of statin activity have not been completely elucidated so far.”
They note that statins could “modulate cancer cell metabolism” via several different mechanisms, such as cell cycle inhibition and induction of apoptosis.
“Moreover, statins modulate the immune response at different levels, including T-cell signalling, antigen presentation, immune cell migration and cytokine production,” the team adds.
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