Beta Blockers with Statins May Decrease All-Cause Mortality in Patients with Cardiovascular Diseases and Locally Advanced Unresectable Non-Small-Cell Lung Cancer after Chemoradiotherapy

Simple Summary Concurrent platinum-based chemoradiotherapy (CRT) followed by maintenance treatment with the PD-L1 inhibitor durvalumab is the most effective therapy in unresectable stage III non-small-cell lung cancer (NSCLC). However, severe toxicity of this approach may lead to an unsatisfactory outcome. Cardiovascular diseases (CVD) may justify the use of sequential CRT to avoid severe adverse events and maintain satisfactory effectiveness. Ensuring that patients with CVD do not have a worse prognosis than patients without CVD is one of the goals of cardio-oncology. It is important that, after sequential CRT as personalized for patients with CVD, there is no increased mortality, and this is the first achievement of this study. Patients receiving beta-blockers and statins had lower all-cause mortality over 2, 3, and 4 years. The clear benefit of treatment with beta-blockers (in possible combination with statin) was confirmed in a subgroup of patients with CVD. The patients with CVD and indications for different cardiac therapy could live significantly longer if they received beta-blockers with or without statins during long-term follow-up. It may be a time to consider beta-blockers and statins as prevention strategy in patients undergoing CRT for NSCLC. The study was conducted in the era when maintenance immunotherapy with durvalumab was not available in clinical practice after chemoradiotherapy (CRT) in unresectable non-small-cell lung cancer (NSCLC). The main aim of the study was to check whether the presence of cardiovascular diseases (CVD) and their pharmacotherapy affects the overall survival (OS) in such NSCLC patients undergoing sequential CRT. The group of 196 patients were analyzed: 101 patients with CVD (51.53%) and 95 patients with other reasons of qualification for sequential CRT (decreased performance status, older age, and other non-cardiovascular co-morbidities). Although patients with CVD were more often in older age, and they more often experienced cardiac and nephrological complications (p < 0.05 for all), there was a statistically nonsignificant trend for lower all-cause mortality in patients with CVD. The lowest all-cause mortality was observed in patients treated with beta-blockers and statins after two (HR = 0.31; 95%CI: 0.1-0.98; p = 0.047), three (HR = 0.33; 95%CI: 0.13-0.81; p = 0.015) and even four (HR = 0.45; 95%CI: 0.22-0.97; p = 0.027) years of follow-up. The benefit in OS remained significant in 101 patients with CVD treated with beta-blockers (HR = 0.65; 95%CI: 0.43-0.99; p = 0.045), and eventually statin, throughout the whole follow-up (log-rank p < 0.05). Further prospective studies are necessary to confirm the role of beta-blockers and statins in reduction of mortality in NSCLC patients undergoing radical CRT.

Automated summary

Concurrent platinum-based chemoradiotherapy (CRT) followed by maintenance treatment with the PD-L1 inhibitor durvalumab is the most effective therapy in unresectable stage III non-small-cell lung cancer (NSCLC). However, severe toxicity may lead to unsatisfactory outcomes. Sequential CRT may be a better choice for patients with cardiovascular diseases (CVD) to avoid adverse events and maintain effectiveness. Beta-blockers and statins can significantly reduce all-cause mortality in these patients, and may serve as a prevention strategy in NSCLC patients undergoing CRT.