1st Revision: Isobel Lester Based on a paper titled “Association of statin use with clinical outcomes in patients with Triple- Negative Breast Cancer”
Original paper: Nowakowska M, Lei X, Thompson M, Shaitelman S, Wehner M, Woodward W et al. Association of statin use with clinical outcomes in patients with triple-negative breast cancer. Journal of Clinical Oncology. 2021;39(15_suppl):523-523.
By: Murielle Nsiela
Statins are groups of drugs used to reduce the amount of cholesterol found in the blood. They achieve this by inhibiting a substance required by the body to make cholesterol; this substance has shown to be upregulated in different types of cancers, including breast cancer[1].
Statins have been shown to exhibit more than one beneficial effect in cell migration, proliferation, and survival, which are all enhanced during a process whereby normal cells turn into cancerous cells[2]. Furthermore, statins may help treat breast cancer, including the most aggressive types such as triple-negative breast cancer (TNBC)[3]. TNBC makes up 10 to 20% of breast cancer and is more aggressive with fewer treatment options and worse outcomes[4]. Therefore, it has been suggested that statins target essential pathways associated with TNBC in addition to increasing the cancer cell death rate [5],[6],[7].
There have been conflicting outcomes concerning whether statins improve the outcome of breast cancer. Some studies have shown a link between statin intake and better outcomes for patients with breast cancer [8],[9],[10]. In contrast, other studies have found the contrary [11]. However, the research carried out by this clinical study aimed to investigate the relationship between the commencement of statin therapy in the twelve months after the patient has been diagnosed with breast cancer. They examined the outcome of women with stage one, two and three breast cancer and focused on breast cancer-specific survival (BCSS) and overall survival (OS) in patients with TNBC. The study involved women aged 66 years and older.
Within the study, 23,192 patients with stage one to three breast cancer met the standards to be included in the study. However, only 2,281 patients were given statins one year after being diagnosed. The results showed a statistically significant relationship between statins and better BCSS and OS in patients with TNBC. Further analysis indicated that women with early-stage TNBC are more likely to have a better outcome with statin intake. However, there was no association between BCSS or OS with patients that did not have TNBC. In addition, the study examined the type and intensity of statin used concerning women with and without TNBC.
Regarding individuals with TNBC, there was statistical significance with L- statins and improved OS. Furthermore, the study suggested that using high-intensity statins provided the most substantial effect on OS in TNBC patients. Conversely, patients with no TNBC did not show much benefit from using statins [12].
In conclusion, there have been studies supporting and providing evidence for the association between statin intake and better survival for patients with TNBC. However, some worldwide studies have also shown conflicting evidence that it is not statistically significant.
Although the use of statins for TNBC treatment may be unclear, this study shows potential for their use in the future. The clinical data indicates that there is a possibility that statins can be used as therapy for patients with TNBC, which supports other studies as well.
References
- Ehmsen S, Pedersen MH, Wang G, et al. Increased cholesterol bio-synthesis is a key characteristic of breast cancer stem cells influencing patient outcome. Cell Rep. 2019;27:3927- 3938.e6
- Beckwitt CH, Brufsky A, Oltvai ZN, Wells A. Statin drugs to reduce breast cancer recurrence and mortality. Breast Cancer Res. 2018;20:144
- Van Wyhe RD, Rahal OM, Woodward WA. Effect of statins on breast cancer recurrence and mortality: a review. Breast Cancer (Dove Med Press). 2017;9:559- 565.
- Yao H, He G, Yan S, et al. Triple- negative breast cancer: is there a treat-ment on the horizon? Oncotarget. 2017;8:1913- 1924
- Bjarnadottir O, Romero Q, Bendahl PO, et al. Targeting HMG- CoA reductase with statins in a window- of- opportunity breast cancer trial. Breast Cancer Res Treat. 2013;138:499- 508.
- Jung HH, Lee SH, Kim JY, Ahn JS, Park YH, Im YH. Statins affect ETS1- overexpressing triple- negative breast cancer cells by restoring DUSP4 deficiency. Sci Rep. 2016;6:33035.
- Liu H, Song Y, Qiu H, et al. Downregulation of FOXO3a by DNMT1 promotes breast cancer stem cell properties and tumorigenesis. Cell Death Differ. 2020;27:966- 983.
- Ahern TP, Pedersen L, Tarp M, et al. Statin prescriptions and breast cancer recurrence risk: a Danish nationwide prospective cohort study. J Natl Cancer Inst. 2011;103:1461- 1468.
- Murtola TJ, Visvanathan K, Artama M, Vainio H, Pukkala E. Statin use and breast cancer survival: a nationwide cohort study from Finland. PLoS One. 2014;9:e110231.
- Borgquist S, Broberg P, Tojjar J, Olsson H. Statin use and breast cancer survival— a Swedish nationwide study. BMC Cancer. 2019;19:54
- Cardwell CR, Hicks BM, Hughes C, Murray LJ. Statin use after diag-nosis of breast cancer and survival: a population- based cohort study. Epidemiology. 2015;26:68- 78
- Nowakowska M, Lei X, Thompson M, Shaitelman S, Wehner M, Woodward W et al. Association of statin use with clinical outcomes in patients with triple-negative breast cancer. Journal of Clinical Oncology. 2021;39(15_suppl):523-523.
