Statin therapy in the treatment of active cancer: A systematic review and meta-analysis of randomized controlled trials

• Published in: PloS one 2018-12, Vol.13 (12), p.e0209486-e0209486
• Main Authors: Farooqi, Mohammed A M, Malhotra, Nikita, Mukherjee, Som D, Sanger, Stephanie, Dhesy-Thind, Sukhbinder K, Ellis, Peter, Leong, Darryl P
• Format: Article
• Language: English
• Subjects: Analysis; Anticancer properties; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bias; Cancer; Care and treatment; Clinical trials; Confidence intervals; Heterogeneity; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Medical prognosis; Medical research; Medicine and Health Sciences; Meta-analysis; Neoplasms - drug therapy; Neoplasms - mortality; Observational studies; Patient outcomes; Patients; Physical Sciences; Prognosis; Progression-Free Survival; Prospero protein; Randomization; Randomized Controlled Trials as Topic; Research and Analysis Methods; Statins; Statistical analysis; Studies; Survival; Systematic review; Therapy; Time Factors
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0209486

Preclinical evidence suggests statins may have anti-tumor properties. Large observational studies are also consistent with improved survival and cancer-specific outcomes among cancer patients on statins. We sought to evaluate the randomized controlled trials of statins in addition to usual anti-cancer therapy. A systematic search of MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, Papers First and Clinicaltrials.gov was performed from inception through to July 4, 2017 to identify randomized clinical trials that investigated statin therapy in cancer patients. Our primary outcome was overall survival and our secondary outcome was progression-free survival. We calculated summary hazard ratio's (HR) and 95% confidence intervals (CI) based on random-effects models using aggregate data. PROSPERO (CRD42017065503). Ten studies with 1,881 individuals were included with 1,572 deaths and a median follow-up of 23 months. All trials included patients with advanced (stage 3 or higher) disease. There was minimal between-study statistical heterogeneity (I2 = 1.8%, for OS; I2 = 0%, for PFS). The pooled HR for overall survival in patients randomized to statins plus standard anti-cancer therapy versus standard therapy alone was 0.94 (95% CI, 0.85 to 1.04). In the 9 studies that reported progression-free survival (1,798 participants), the pooled HR for statin plus standard therapy versus standard therapy alone was 0.97 (95% CI, 0.87 to 1.07). In patients with advanced cancer and a prognosis