efficacy of combined bevacizumab and angiotensin-converting enzyme inhibitors or angiotensin ii type 1 receptor blockers in metastatic colorectal cancer patients

Background: bevacizumab, used in the treatment of metastatic colorectal cancer (mcrc), has an angiogenesis inhibitory effect. angiotensin converting enzyme inhibitors (acei) and angiotensin ii type 1 receptor blockers (arbs) used in the treatment of arterial hypertension demonstrate antitumoural effects through different pathways. in our study, we aimed to investigate whether acei or arb has a synergistic effect on survival in patients receiving bevacizumab treatment.method: a total of 208 patients receiving bevacizumab for mcrc were included in this retrospective study. we divided the patients into two groups as renin angiotensin system inhibitors (rasi) users and non-users. we compared the progressin-free survival (pfs) and overall survival (os) times between the 2 groups. kaplan-meier and cox regression analyses were used for statistical analyses.results: in this study, 53 patients with rasis and 155 without rasis were included. the rasis group had a median pfs of 8.66 months, while the non-rasis group had a median of 6.67 months (p = 0.034; p < 0.05). the rasis group had a median os of 24.86 months, while the non-rasis group had a 18.71 months (p = 0.039; p < 0.05). in the rasis group, multivariate analysis showed pfs [hazard ratio (hr): 1.425 (95% confidence interval (ci): 1.037-1.959), p = 0.029] and os [hr: 1.371 (95% ci: 1.001-1.897), p = 0.044].conclusion: bevacizumab in combination with acei or arbs prolongs pfs and os in patients with mcrc. prioritising acei and arbs in patients with mcrc and arterial hypertension provides a survival advantage. these findings should be supported through further studies involving larger patient populations and addressing other factors that may affect prognosis.