Repurpose Study Puts Forward Propranolol As Possible Melanoma Agent

Newly diagnosed melanoma patients given propranolol may have a longer time to disease recurrence than nonusers

  • Date: 03 Oct 2017
  • Author: By Lynda Williams, Senior medwireNews Reporter
  • Topic: Skin Cancers / Melanoma

medwireNews: Propranolol could play an adjuvant role in the primary treatment of melanoma, following study findings indicating improved progression-free survival (PFS) with off-label use of the β-blocker.

“These results confirm [the] recent observation that β-blockers protect patients with thick cutaneous melanoma from disease recurrence”, say Vincenzo De Giorgi, from the University of Florence in Italy, and co-workers.

But they emphasize: “The development of randomized placebo-controlled clinical trials is necessary to clarify a definitive role for β-blockers in protecting against the risk of progression of melanoma and to potentially identify the receptor subtype involved in the protective effect.”

The researchers recruited 53 patients with stage IB–IIIA cutaneous melanoma without metastases, 19 of whom agreed to use off-label propranolol 80 mg/day from diagnosis as an adjuvant therapy. None of these patients discontinued β-blocker therapy during a median 3 years of follow-up.

The propranolol and non- propranolol groups were comparable at diagnosis for demographic and primary prognostic markers, except for ulcerated melanoma, a predictor of poor outcome, which was significantly more common in the patients who agreed to use propranolol.

Disease progression occurred in 15.8% of propranolol users versus 41.2% of those not taking the agent.

Use of propranolol was associated with a significant improvement in the 3-year rate of disease-free survival (89 vs 64%).

And COX analysis adjusting for age, Breslow thickness and ulceration indicated that propranolol use was associated with an approximate 80% reduction in the risk of recurrent melanoma (hazard ratio=0.18).

One death was attributed to melanoma in the propranolol-treated patients versus five deaths in the control group. But a significant improvement in overall survival was not detected, which the researchers attribute to lack of statistical power associated with the short follow-up period.

Writing in JAMA Oncology, the team remarks: “This study is in accordance with the present policy of ‘drug repurposing’ in oncology.

“Repurposing the vast arsenal of approved drugs with a nononcology primary purpose may prove an attractive and inexpensive strategy for offering more effective treatment options to patients with cancer.”

Reference

De Giorgi V, Grazzini M, Benemei S, et al. Propranolol for off-label treatment of patients with melanoma. Results from a cohort study. JAMA Oncol; Advance online publication 28 September 2017. doi:10.1001/jamaoncol.2017.2908

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