Effect of antihypertensive drugs on survival in patients with non-small cell lung cancer on epidermal growth factor receptor inhibitors

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) show efficacy against non-small cell lung cancer (NSCLC) in patients with EGFR mutations. However, the impact of antihypertensive medications, particularly beta-blockers (BBs) and renin-angiotensin system blockers (RASBs), on survival outcomes in this population remains controversial. We evaluated the effects of BBs and RASBs on progression-free survival (PFS) and overall survival (OS) in patients with NSCLC receiving EGFR-TKIs. This retrospective study included patients diagnosed with NSCLC who received EGFR-TKIs at a regional teaching hospital in Taiwan between 2009 and 2023. Overall, 308 patients were categorized into groups: EGFR-TKIs only (n=175), BBs(+)/EGFR-TKIs(+) (n=70), and RASBs(+)/EGFR-TKIs(+) (n=63). Primary and secondary outcomes were PFS and OS, respectively. Multivariate Cox proportional-hazards models were used for analysis. Median PFS was 7.79, 11.74, and 10.42 months in the EGFR-TKIs only, BBs(+)/EGFR-TKIs(+), and RASBs(+)/EGFR-TKIs(+) groups, respectively (<i>P</i>=0.056). However, OS was higher in BBs(+)/EGFR-TKIs(+) (17.79 months) and RASBs(+)/EGFR-TKIs(+) (16.64 months) groups than in the EGFR-TKIs only group (12.59 months) (<i>P</i>=0.009). Multivariate analysis identified concomitant BBs or RASBs with EGFR-TKIs as independent prognostic factors for improved OS, particularly in patients without skin toxicity and with favorable Eastern Cooperative Oncology Group performance status. BBs and RASBs have a potential adjunctive role in NSCLC therapy.