The renin-angiotensin system blockers as adjunctive therapy for cancer: a meta-analysis of survival outcome.

The renin-angiotensin system blockers (RASBs), including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), are widely used to reduce cardiovascular disease (CVD) events. Accumulating pre-clinical and clinical studies suggested that RASBs possesses anti-carcinogenic properties, and their use is associated with favorable outcomes in several type cancers. To conduct a meta-analysis to evaluate the effect of adjunctive therapy of renin-angiotensin system blockers combined with chemotherapeutic agents in cancer patients.Data from a total of 2436 patients from 7 retrospective studies investigating chemotherapeutic agents in combination with RASBs agents versus chemotherapeutic agents were included in this meta-analysis. Publication bias was assessed by the Begg's Test, Egger's test and funnel plot. Subgroup analysis was conducted when the chemotherapeutic agents were the same.A significant reduction in overall mortality in favor of chemotherapeutic agents in combination with RASBs agents was observed, hazard ratio (HR) 0.80 (95% CI: 0.69-0.92); there was a significant decrease in the risk of disease progression in favor of chemotherapeutic agents in combination with RASBs regimens, HR 0.79 (95% CI: 0.66-0.94), compared with those who only used chemotherapeutic agents. Subgroup analysis indicated that platinum-based agents plus ACEI/ARB could increase significantly the survival outcome (HR = 0.56; 95% CI: 0.38-0.82).Our results suggest that RASBs combined with chemotherapeutic agents may improve outcomes in multiple types' cancer patients. More research and well-designed, rigorous, large clinical trials are required to address these issues.