Can Hypertension Improve Ovarian Cancer Survival?

Ovarian cancer kills more women each year than any other gynecologic cancer, and, unlike many other types of tumors, over the past few decades the disease has not seen any breakthrough treatments that drastically improve survival. However, a recent study published in Cancer Causes & Control outlined correlations between common comorbidities, like hypertension, heart disease and diabetes and ovarian cancer prognosis.

Researchers noted that this information may be able to be used in the future to better guide treatment — and improve outcomes – for patients with ovarian cancer.

The study examined associations between a history of hypertension, heart disease, diabetes and medications for these conditions and the overall survival (OS) and progression-free survival (PFS) in patients with invasive epithelial ovarian cancer. Data was pooled from 15 studies participating in the Ovarian Cancer Association Consortium.

Ultimately, the study found that a history of diabetes (7,674 patients) was associated with an increased risk of death from ovarian cancer, while that was not the case for mortality associations found with hypertension (6,482 patients) or heart disease (4,252 patients).

professor at Roswell Park and the University at Buffalo

“Diabetes is a condition characterized by increased exposure to hyperinsulinemia and hyperglycemia, which can promote growth of tumor cells and activation of certain genetic pathways leading to cancer progression. Perhaps these mechanisms are underlying the associations for diabetes we observed in our study,” Kirsten B. Moysich, Ph.D., M.S., , and author on the study said in an interview with CURE.

One possible explanation behind the correlation between diabetes and lower OS is that hyperinsulinemia, which is common in older people who have diabetes, may lead to the activation of the Ras-MAPK and PI 3-K-mTOR pathways. These pathways can play a role in tumor cell proliferation and, ultimately, the cancer’s progression. Also, hyperglycemia may promote tumor growth by giving the cancer cells glucose as a source of energy.

“This finding is particularly important in the context of a growing number of individuals with diabetes,” Albina Minlikeeva, Ph.D., M.P.H., postdoctoral Research Affiliate with Roswell Park’s Department of Cancer Prevention and Control and author on the study said in an interview with CURE, noting that it is important for clinicians to be aware if their patients have diabetes and that they may be at increased risk for death.

When it came to hypertension’s correlation to mortality, the researchers said that they were surprised to see an inverse association.

Further, the medications that are used to treat these conditions can also play a role in ovarian cancer survival.

Ever-use of beta blockers, oral antidiabetic medication and insulin were associated with increased mortality, and the use of diuretics were inversely associated with mortality, the study found.

“Most likely, use of antihypertensive medications, such as diuretics, ACE inhibitors and calcium channel blockers, could explain our results in relation to hypertension. This is consistent with recent findings that ovarian cancer patients who took nonselective beta-blockers lived longer after their diagnosis,” Minlikeeva said.

Understanding a patient’s complete medical makeup — not just their cancer – may one day lead the breakthroughs that are much needed for this group of patients.

“More importantly, integration of the full clinical profile for ovarian cancer patients may be essential in understanding the factors related to their overall morbidity and mortality,” the study says.

But for now, the authors say that more research needs to be done, in both the pre-clinical and clinical settings to confirm the speculations.

“We are planning on conducting more research investigating the role of various comorbidities and medications in relation to ovarian cancer and risk prognosis,” Minlikeeva said.