PROPRANOLOL MAY BE HELPFUL IN MELANOMA

Propranolol may extend progression-free survival in cutaneous melanoma, according to a small prospective study.

“These results confirm recent observations that beta-blockers protect patients with thick cutaneous melanoma from disease recurrence,” Dr. Vincenzo De Giorgi of the University of Florence, in Italy, and colleagues write in their September 28 online report in JAMA Oncology.

Laboratory studies have shown that beta-blockers prevent angiogenesis and melanoma cell migration by blocking noradrenaline-dependent responses, the authors note. They also point out that chronic stress seems to contribute to the progression of cancer, including melanoma.

In 2011, De Giorgi and a somewhat different team of researchers found that melanoma patients taking beta-blockers for other diseases had a reduced risk of disease progression.

The current study included 53 patients with stage IB to IIIA melanoma. Nineteen agreed to take 80 mg of propranolol daily as off-label adjuvant treatment; the 34 who refused propranolol served as a control group.

With a median follow-up of three years, 14 of the controls(41.2%) had melanoma progression, versus three of the patients who took the beta-blocker (15.8%). Six patients who did not use propranolol (17.7%) died, five due to melanoma; two of the propranolol users (10.5%) died, one from melanoma. The adjusted hazard ratio for disease progression associated with propranolol use was 0.18 (P=0.03).

Demographic and clinical characteristics were similar between propranolol users and nonusers, the researchers note, although patients on the beta-blocker were more likely to have ulceration.

“The development of randomized placebo-controlled clinical trials is necessary to clarify a definitive role for beta-blockers in protecting against the risk of progression of melanoma and to potentially identify the receptor subtype involved in the protective effect,” they conclude.

Dr. De Giorgi was not available for an interview by press time