Prescription drugs and cutaneous melanoma
Background
Previous studies have demonstrated that Norwegian men have more advanced disease at the time of melanoma diagnosis compared to women, and that Norway has more advanced disease compared to similar countries. The costs related to melanoma are increasing significantly, particularly with the introduction of expensive drugs for treating advanced disease. Therefore, it is of great importance to identify less costly factors that can contribute to improving the prognosis for melanoma of the skin.
Certain medications affect the immune system and sensitivity to UV radiation, which can also impact melanoma development. Relevant in this context are medications used for cardiovascular disease, particularly blood pressure-regulating medications. Laboratory studies have shown that beta-blockers inhibit cancer processes. The use of beta-blockers might thus serve as a means to reduce the risk of melanoma recurrence and mortality.
Beta-blockers are inexpensive, safe, and widely used medications. More than 800,000 Norwegians were using these blood pressure-regulating medications in 2015, and their usage is increasing.
Purpose
In a national cohort of all melanoma patients diagnosed between 2005 and 2018 (n=18,000), we are investigating whether the use of blood pressure-regulating medications (type, dose, duration) is associated with melanoma, new primary melanoma, melanoma recurrence/metastasis development, and death. We aim to answer the following research questions:
- Is there an association between the use of selective and non-selective beta-blockers and disease-free survival after melanoma, according to stage and clinical factors?
- Is there an association between the use of selective and non-selective beta-blockers and disease-free survival after different types of skin melanoma?
- Is there an association between the use of selective and non-selective beta-blockers and disease-free survival after melanoma, according to demographic factors?
Our hypothesis is that beta-blockers inhibit melanoma progression and consequently improve survival.
Beta-blocker use will be analyzed using the Intention-to-treat (ITT) method. "New users" are defined as those with a first beta-blocker prescription within three months before melanoma diagnosis, while "prevalent users" have prescriptions before this period. The outcome measure is disease-free survival (time between melanoma diagnosis and new primary disease, melanoma recurrence, or melanoma-related death).
The analyses will control for factors such as age, gender, UV exposure based on residence, and socioeconomic conditions. Blood pressure-regulating medications are widely used and cost-effective. If this study can demonstrate that such medications might have beneficial "side effects" that improve the prognosis for melanoma, it would be of clinical relevance both nationally and internationally. The key advantages of conducting this project are the epidemiological approach, the extensive follow-up of melanoma patients using nationwide data, resulting in time and cost savings.
The study is based on data from the Cancer Registry (including the melanoma quality registry), the Prescription Registry, the Cause of Death Registry, and Statistics Norway.
Ghiasvand R, Berge LAM, Andreassen BK, Stenehjem JS, Heir T, Karlstad Ø, Juzeniene A, Larsen IK, Green AC, Veierød MB, Robsahm TE. Use of antihypertensive drugs and risk of cutaneous melanoma: a nationwide nested case-control study. Int J Epidemiol. 2023 Jun 6;52(3):887-898. doi: 10.1093/ije/dyac223. PMID: 36413027; PMCID: PMC10244056.
Ghiasvand R, Berge LAM, Andreassen BK, Green AC, Al Rahmoun M, Fournier A, Kvaskoff M, Veierød MB, Robsahm TE. Statin use and risk of cutaneous melanoma: a nationwide nested case-control study. Br J Dermatol. 2023 May 24;188(6):805-807. doi: 10.1093/bjd/ljad057. PMID: 36866569.
Al Rahmoun M, Ghiasvand R, Cairat M, Mahamat-Saleh Y, Cervenka I, Severi G, Boutron-Ruault MC, Robsahm TE, Kvaskoff M, Fournier A. Statin Use and Skin Cancer Risk: A Prospective Cohort Study. J Invest Dermatol. 2022 May;142(5):1318-1325.e5. doi: 10.1016/j.jid.2021.10.010. Epub 2021 Oct 23. PMID: 34695411.
