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Targeting Tumor Metabolism With Statins During Treatment for Advanced-stage Pancreatic Cancer

Iarrobino, Nick A., BSc*; Gill, Beant, MD; Bernard, Mark E., MD; Mishra, Mark V., MD§; Champ, Colin E., MD

American Journal of Clinical Oncology: November 2018 - Volume 41 - Issue 11 - p 1125–1131
doi: 10.1097/COC.0000000000000433
Original Articles: Gastrointestinal

Introduction: A growing body of preclinical data suggests that statins may exert potent antitumor effects, yet the interactions of these medications with standard therapies and clinical outcomes in this population is less clear. We assessed the impact of statin use on outcomes in patients with advanced-stage pancreatic adenocarcinoma undergoing various treatments.

Materials and Methods: After institutional review board approval, we conducted a retrospective-cohort study consisting of 303 newly diagnosed advanced-stage pancreatic adenocarcinoma patients to determine the impact of statin use on outcomes. Univariate and multivariable Cox proportional hazard regression models were utilized to estimate hazard ratios (HRs). Time-to-event was estimated using Kaplan-Meier survival analysis for overall survival, distant metastasis, and locoregional failure. Baseline and active statin usage were assessed and to mitigate risk of immortal time bias, subanalysis excluding patients with under 6 months of follow-up was conducted.

Results: Both prior (P=0.021) and active (P=0.030) statin usage correlated with improved survival in this cohort. Surgery, chemoradiation, and statin use improved 2-year survival rates (84.1% vs. 55.0%; P<0.001). On multivariable analysis, statin exposure was associated with overall survival (HR, 0.662; P=0.027) and trended to significance for freedom from distant metastasis (HR, 0.577; P=0.060). Comorbid conditions were not significantly associated with outcomes.

Conclusions: Statin use was associated with improved overall survival in advanced-stage pancreatic adenocarcinoma patients. This data supports previous findings in early-stage pancreatic adenocarcinoma and other cancer sites. To our knowledge this is the first report to examine the efficacy of statin use as a supplementary treatment option in advanced-stage pancreatic adenocarcinoma patients.

*University of Pittsburgh School of Medicine

Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA

Department of Radiation Medicine, University of Kentucky, Lexington, KY

§Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD

Supported by the National Institute of Health grant award number T35DK065521.

The authors declare no conflicts of interest.

Reprints: Colin E. Champ, MD, Department of Radiation Oncology, University of Pittsburgh Medical Center, 815 Freeport Road, Pittsburgh, PA 15215. E-mail: champce@upmc.edu.

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