Drugs and prognosis for melanoma
Project
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The Cancer Registry of Norway conducts several research studies focusing on how the use of different medications affects the risk of cancer in the population.
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.
About the project
Project leader: Trude Eid Robsahm
Ass. Project leader: Reza Ghiasvand (postdoctoral fellow)
Project participants:
- Nathalie Støer, statistician
- Edoardo Botteri, researcher
- Marit B. Veierød, Professor, Institute of Basic Medical Sciences, University of Oslo
- Kristin A. Taskén, Professor, Dept. of Tumor Biology, Department of Cancer Research, OUS
- Helene Grytli, Postdoctoral Fellow, Dept. of Tumor Biology, Institute for Cancer Research, OUS
- Øystein Karlstad, researcher, Norwegian Prescription Database, Norwegian Institute of Public Health
- Adele Green, professor, QIMR, Berghofer Medical Research Institute, Brisbane, Australia
- Kiarash Khosrotehrani, dermatologist, Experimental Dermatology Group, University of Queensland, Brisbane, Australia
REK: The project has been approved by the Regional Committees for Medical and Health Research Ethics (South-East).
Funding: The project is funded as a doctoral project through the South-Eastern Norway Regional Health Authority
Project period: 2019-2025