Brief Communication on the Impact of β-blockers on Outcomes in Patients Receiving Cancer Immunotherapy

Preclinical studies show that β-adrenergic activation suppresses the immune system and reduces the effectiveness of cancer immunotherapy. As a result, there is considerable interest in using β-blockers (BBs), a cheap and safe class of medication, in combination with immunotherapy to improve outcomes in cancer. This study is a systematic review and meta-analysis of clinical studies. A comprehensive literature search was performed up to May 2022. Studies were included if they reported hazard ratios (HRs) of overall survival (OS), all-cause mortality or progression-free survival (PFS) associated with BBs in patients with solid organ cancer treated with immunotherapy. Study-specific HRs and 95% confidence intervals were pooled in random effects meta-analyses. Nine studies involving over 6350 patients with melanoma, lung, renal, urothelial, or other solid cancers treated with a range of immunotherapies met the inclusion criteria. Across all studies combined, there was no association between concomitant BB use and OS (HR 0.99, 0.83–1.18) or PFS (HR 0.97, 0.89–1.05). In subgroup analyses, BB use made no difference to OS or PFS in melanoma (OS HR 0.66, 0.33–1.34; PFS HR 0.81, 0.62–1.05) or to OS in lung cancer (OS HR 1.00, 0.49–2.07). In summary, this study found no evidence that BBs enhance immunotherapy effectiveness.