A retrospective analysis found that in patients with muscle-invasive bladder cancer (MIBC) undergoing neoadjuvant chemotherapy (NAC) prior to radical cystectomy, those who were taking angiotensin-converting enzyme inhibitors (ACEi) experienced increased pathologic complete responses (pCR). Researchers speculated that ACEi may amplify the effects of NAC. The renin-angiotensin system plays a role in the proliferation of cells, blood cells, and connective tissue; it can also be involved in immunosuppression. Previous studies have suggested that ACEi and angiotensin receptor blockers (ARB) may suppress tumor growth, possibly by blocking transforming growth factor-β, which plays a role in bladder cancer. Researchers retrospectively reviewed the outcomes of 133 males and 54 females with MIBC who were either treated or not treated with ACEi or ARB while they were receiving NAC prior to radical cystectomy. Of the 187 patients reviewed, 41 (21.9%) were taking ACEi and 146 (78.1%) were not. An ARB was taken by 24 (12.8%) patients. Among the 41 patients taking ACEi, 17 (41.5%) achieved a pCR, while only 36 (24.7%) of the 146 patients who were not taking ACEi achieved a pCR. Multivariable analysis identified only ACEi intake as being associated with pCR. ARB intake was not associated with pCR. The only factor associated with significantly improved overall survival (OS) was pCR. After adjusting for pCR, ACEi was not significantly prognostic of OS. That is, while ACEi intake was associated with achieving a pCR, it was not prognostic of OS; the researchers speculated that this finding is due to the presence of other factors that could result in patient death. OS was also unaffected by ARB intake while receiving NAC.

  1. Thomas J. Impact of angiotensin inhibitors on pathologic complete response with neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC). ASCO Genitourinary Cancers Symposium, 11–13 February 2021.