Efficacy of Combined Bevacizumab and Angiotensin-Converting Enzyme Inhibitors or Angiotensin II type 1 Receptor Blockers in Metastatic Colorectal Cancer Patients

Background: Bevacizumab, used in the treatment of metastatic colorectal cancer (mCRC), has an angiogenesis inhibitory effect. Angiotensin converting enzyme inhibitors (ACEi) and angiotensin II type 1 receptor blockers (ARBs) used in the treatment of arterial hypertension demonstrate antitumoural effects through different pathways. In our study, we aimed to investigate whether ACEi or ARB has a synergistic effect on survival in patients receiving bevacizumab treatment.Method: A total of 208 patients receiving Bevacizumab for mCRC were included in this retrospective study. We divided the patients into two groups as Renin Angiotensin System inhibitors (RASi) users and non-users. We compared the progressin-free survival (PFS) and overall survival (OS) times between the 2 groups. Kaplan-Meier and Cox regression analyses were used for statistical analyses.Results: In this study, 53 patients with RASIs and 155 without RASIs were included. The RASIs group had a median PFS of 8.66 months, while the non-RASIs group had a median of 6.67 months (P = 0.034; P < 0.05). The RASIs group had a median OS of 24.86 months, while the non-RASIs group had a 18.71 months (P = 0.039; P < 0.05). In the RASIs group, multivariate analysis showed PFS [hazard ratio (HR): 1.425 (95% confidence interval (CI): 1.037-1.959), P = 0.029] and OS [HR: 1.371 (95% CI: 1.001-1.897), P = 0.044].Conclusion: Bevacizumab in combination with ACEi or ARBs prolongs PFS and OS in patients with mCRC. Prioritising ACEi and ARBs in patients with mCRC and arterial hypertension provides a survival advantage. These findings should be supported through further studies involving larger patient populations and addressing other factors that may affect prognosis.