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Statin use is associated with improved epithelial ovarian cancer survival

Women with ovarian cancer had significantly better survival if they were on statin therapy in addition to cancer-specific treatment, a review of registry-based data showed.

A study of 126 patients with advanced epithelial ovarian cancer (stages III and IV) undergoing primary cytoreductive surgery showed improved survival of women who were statin users compared to non-users (1). Median progression-free survival for statin users was 24 months, compared to 16 months for statin non-users. Overall survival was significantly longer for statin users (62 months) compared to statin non-users (46 months).

Statins are normally used to lower cholesterol and prevent cardiovascular disease. It has been suggested that statin use can protect against the development of some cancers by inhibiting tumour growth and improve cancer survival rates. Evidence in relation to statin use and ovarian cancer has shown:

  • Ovarian cancer patients who use statin, as well as undergo cancer-specific treatment, may have improved cancer survival rates, and
  • Statin users may have a decreased risk of developing ovarian cancer.

Improving survival rates

Ovarian cancerOvarian cancer is often detected in the later stages making the prognosis poorer. Hence, anti-cancer drugs that can improve survival rates can have great implications.

A retrospective cohort study of 442 patients with stages I to IV ovarian cancer treated between 1992 to 2013 showed a survival benefit only in patients with non-serous tumours (2). The participants were divided into three groups: patients with hyperlipidemia (high cholesterol) who used statins (n = 68), patients with hyperlipidemia who did not use statins (n = 28), and patients without hyperlipidemia (n = 346). When the entire cohort was analysed there was no significant differences in survival rates, only non-serous-papillary ovarian cancer.

In a Society of Gynaecologic Oncology Meeting that was held last month in San Diego, a study of 1,510 Medicare-age women, of which 636 were undergoing statin therapy, statin use was associated with a 34% reduction in the risk of dying (3). The study assessed woman in 2007 to 2009 who had undergone primary debulking surgery.  The survival benefit was limited to lipophilic statin agents and to use of moderate and high-dose therapy. Patients on low-dose statin therapy had survival similar to those who did not use statin. Statin users had a median overall survival of 32.2 months versus 28.7 months for non-users. Patients with stage III disease had a greater survival benefit with statin use (31.7 versus 25.9 months). The statin benefit applied to patients with serous and nonserous tumors, whereas the previous study above only applied to non-serous.

Statins impact on ovarian cancer patients warrants further investigation with respect to different histological subtypes.

Preventing Cancer

It has also been suggested statin use may prevent ovarian cancer from developing in the first instance. A reduction in the availability of cholesterol may limit cancer cellular production and thus inhibit cancer growth and spread (4).

In a Danish case-control study of 4103 epithelial ovarian cancer cases (2731 serous, 650 endometrioid, 459 mucinous and 263 clear cell) and 58, 706 controls statin use was not associated with risk for overall epithelial or serous ovarian cancer (5). The researchers found an inverse association with respect to non-serous types of epithelial ovarian cancer, between statin use and risks for mucinous and endometrioid tumours.

Findings from five studies were pooled in a meta-analysis which assessed statin use and ovarian cancer risk (4). The analysis found a significant 21% risk reduction and the association increased (52% reduction) for ovarian cancer in long-term statin use of five years or more. The same analysis also assessed endometrial cancer risk, and there was no association between statin use and endometrial cancer. The effect of statin use against cervical cancer and vulvar cancer risk was not conclusive.

Can Statin be used as an anti-cancer drug?

The use of statins for reducing mortality and morbidity in cardiovascular diseases has been well established. However, the role of statins to prevent and increase survival in cancer is still less clear. Further dedicated studies are needed, as well as translation to clinical trials on statin use as a therapy in women with ovarian cancers. While there is not enough evidence to prescribe Statins as an anti-cancer drug at present, I am very positive for patients who are on statins for other reasons, to remain on them.

References

  1. Elmore R, Ioffe Y, Scoles D et al. Impact of statin therapy on survival in epithelial ovarian cancer. Gynecol Oncol. 2008;111(1):102-5.
  2. Habis M, Wroblewski K, Bradaric M et al. Statin therapy is associated with improved survival in patients with non-serous-papillary epithelial ovarian cancer: a retrospective cohort analysis. PLoS One. 2011;9(8):e104521.
  3. Bankhead, C. 2016. SGO: Ovarian Cancer Survival Benefit With Statins http://www.medpagetoday.com/clinical-context/GynecologicCancers/56990
  4. Liu Y, Qin A, Li T et al. Effect of statin on risk of gynecologic cancers: A meta-analysis of observational studies and randomized controlled trials. 2014;133(3):647-655.
  5. Baandrup L, Dehlendorff C, Friis S, et al. Statin use and risk for ovarian cancer: a Danish nationwide case–control study. British Journal of Cancer 2015;112:157–61.

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