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ACE inhibitors, ARBs may reduce risk of nonmelanoma skin cancer in high-risk patients, researchers report

Wednesday, September 10 2008 | Comments

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What's This? In patients at high risk for developing skin cancer, users of ACE inhibitors or angiotensin II receptor blockers may have a lower risk of nonmelanoma skin cancers relative to nonusers, study results indicate.

"Results of animal and in vitro studies have demonstrated that angiotensin II may promote angiogenesis in cancer cells and thereby participate in tumorigenesis," the authors of the study wrote.

To test this hypothesis, the researchers conducted a cohort study using data from 1,051 participants in the randomized VATTC trial, all of whom were at increased risk of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). The participants were examined every 6 months by a dermatologist and were followed for as long as 6 years (median follow-up, 3.4 years).

Overall, 472 of the participants received a diagnosis of >=1 BCC during follow-up (208 ACE inhibitor/ARB users vs 264 nonusers), with absolute BCC incidence rates of 154 cases per 1,000 person-years among the ACE inhibitor/ARB users and 233 cases per 1,000 person-years among the nonusers. This translated into a statistically significant 34% reduction in the incidence rate ratio for BCC among the ACE inhibitor/ARB users versus the nonusers, according to a crude analysis.

Further, 309 of the participants received a diagnosis of >=1 SCC during follow-up (132 ACE inhibitor/ARB users vs 177 nonusers), with absolute SCC incidence rates of 83 per 1,000 person-years in the ACE inhibitor/ARB users and 141 per 1,000 person-years in the nonusers. This translated into a statistically significant 42% reduction in the incidence rate ratio for SCC among the ACE inhibitor/ARB users versus the nonusers.

However, treatment with ACE inhibitors/ARBs had no effect on the participants' risk of cancer-specific or overall mortality, the authors noted. Also, no benefits in BCC or SCC incidence were observed with other antihypertensive drugs, "which implies that the association reflects the specific biologic mechanisms of action of ACE inhibitors and ARBs and not their general antihypertensive effects," they wrote.

"If these novel findings are confirmed in a randomized, controlled trial, they may lead to prevention of these very common cancers, at least among individuals at very high risk," the authors concluded.

These findings were published online Aug. 26 ahead of print in the Journal of the National Cancer Institute by Christian JB, et al.

This information concerns a use that has not been approved by the Food and Drug Administration.

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