ADJUVANT B-BLOCKER USE FOR MELANOMA

An Italian single-center prospective cohort study suggests that adjuvant treatment with the beta-blocker propranolol significantly reduces the risk of melanoma recurrence in patients with stage IB to IIIA cutaneous disease. The findings were reported in JAMA Oncology by De Giorgi et al. Preclinical and retrospective studies have indicated that beta-blockers inhibit angiogenesis and interfere with the migration of melanoma cells via inhibition of noradrenaline-dependent responses.

Study Details

In the study, 53 patients with stage IB to IIIA cutaneous melanoma and no evidence of metastasis in the Department of Dermatology, University of Florence, were asked at the time of diagnosis between January 2011 and April 2013 to take propranolol at 80 mg daily as off-label adjuvant treatment after surgery. Of them, 19 accepted propranolol treatment and 34 declined but agreed to participate as a control group. Baseline characteristics were similar in the two groups except for a higher proportion of patients with ulcerated melanoma in the propranolol group (63% vs 35%).

Disease-Free Survival

After a median follow-up of 3 years, disease progression had occurred in 3 patients (15.8%) in the propranolol group and 14 patients (41.2%) in the control group. Disease-free survival at 3 years was 89% vs 64%, respectively. In an analysis adjusting for age, Breslow thickness, and ulceration, propranolol use was associated with a significantly reduced risk of recurrence (hazard ratio [HR] = 0.18, P = .03).

Two patients in the propranolol group died (10.5%), one due to melanoma. Six patients in the control group died (17.7%), five due to melanoma. No significant difference in overall survival was observed (HR = 0.64, P = .63).

The investigators concluded: “In the absence of randomized, double-blind, placebo-controlled clinical trials, this study is the first off-label study of which we are aware of propranolol for melanoma treatment. These results confirm recent observation that β-blockers protect patients with thick cutaneous melanoma from disease recurrence. This study is in accordance with the present policy of ‘drug repurposing’ in oncology. Repurposing the vast arsenal of approved drugs with a non-oncology primary purpose may prove an attractive and inexpensive strategy for offering more effective treatment options to patients with cancer.”

Vincenzo De Giorgi, MD, of the Department of Dermatology, University of Florence, Italy, is the corresponding author of the JAMA Oncology article.