Efficacy and safety profile of statins in patients with cancer: a systematic review of randomised controlled trials

• Published in: European journal of clinical pharmacology Vol. 76; no. 12; pp. 1639 - 1651
• Main Authors: Thomas, John P., Loke, Yoon K., Alexandre, Leo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2020; Springer Nature B.V
• Subjects: Biomedical and Life Sciences; Biomedicine; Clinical trials; Dose-Response Relationship, Drug; Drug Administration Schedule; Esophagus; Hepatocellular carcinoma; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Liver cancer; Malignancy; Mortality; Neoplasms - drug therapy; Neoplasms - mortality; Pancreas; Pharmacology/Toxicology; Pravastatin; Pravastatin - administration & dosage; Pravastatin - adverse effects; Progression-Free Survival; Randomized Controlled Trials as Topic; Review; Safety; Solid tumors; Statins; Systematic review; Time Factors; Tumors; Clinical trials; HMG-CoA; Statin; Adverse effects; Cancer
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-020-02967-0

Purpose A growing body of preclinical and observational research suggests that statins have potential as a therapeutic strategy in patients with cancer. This systematic review of randomised controlled trials (RCTs) in patients with solid tumours aimed to determine the efficacy of statin therapy on mortality outcomes, their safety profile and the risk of bias of included studies. Methods Full-text articles comparing statin therapy versus control in solid tumours and reporting mortality outcomes were identified from Medline and Embase from conception to February 2020. A systematic review with qualitative (primarily) and quantitative synthesis was conducted. This systematic review was prospectively registered (Prospero registration CRD42018116364). Results Eleven trials of 2165 patients were included. Primary tumour sites investigated included lung, colorectal, gastro-oesophageal, pancreatic and liver. Most trials recruited patients with advanced malignancy and used sub-maximal statin doses for relatively short durations. Aside from one trial which demonstrated benefit with allocation to pravastatin 40 mg in hepatocellular carcinoma, the remaining ten trials did not demonstrate efficacy with statins. The pooled hazard ratio for all-cause mortality with allocation to pravastatin in patients with hepatocellular carcinoma in two trials was 0.69 (95% confidence interval CI 0.30–1.61). Study estimates were imprecise. There were no clinically important differences in statin-related adverse events between groups. Overall, included trials were deemed low risk of bias. Conclusion The trial evidence is not sufficiently robust to confirm or refute the efficacy and safety of statins in patients with solid malignant tumours. Study and patient characteristics may explain this uncertainty. The potential role of high-dose statins in adjuvant settings deserves further research.