Poster Presentation Australasian Society for Dermatology Research Annual Scientific Meeting 2024

Associations between beta-blocker use and cutaneous melanoma outcomes: a systematic review and random effects meta-analysis. (#123)

Nicholas M Muller 1 2 , Samuel X Tan 1 2 , Nisal Vipulaguna 2 , Chenhao Zhou 2 , Maria Celia B Hughes 2 , Peter Soyer 2 , Lena von Shuckmann 1 2 , Kiarash Khosrotehrani 1 2
  1. Dermatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  2. Frazer Institute, University of Queensland, Woolloongabba, Queensland, Australia

Introduction & Objectives:

This systematic review and meta-analysis investigates the potential role of beta-blockers in cutaneous melanoma management. Beta-adrenoceptors are upregulated in cancers, including melanoma, and beta-blockers – have been shown to inhibit angiogenesis and tumour cell migration in pre-clinical models. However, clinical evidence for their use in modulating melanoma patients’ outcomes remains sparse.

 

Materials & Methods:

Our PRISMA-adherent meta-analysis included eleven independent cohorts across twelve articles, comprising 4904 beta-blocker users and 16678 non-users. Primary outcomes included disease-free (DFS), recurrence-free (RFS), melanoma-specific (MSS), and overall survival (OS). The main effect size was the adjusted hazard ratio (aHR) with 95% confidence interval. Risk of bias was assessed using the Cochrane ROBINS-I tool. Nine cohorts included Cox regression models and were included in the random effects pooled meta-analysis.

 

Results:

No significant associations were found between beta-blocker use and either MSS or OS, though we identified a trend favouring the use of specifically pan-selective beta-blockers compared to cardio-selective blockers. A remarkable beneficial association was found with DFS; however, we approach these results cautiously as they were all retrieved from studies by the same group. The study designs were largely observational and varied in disease stage, beta-blocker selectivity, and timeframe. In modern practice, most beta-blocker prescriptions are cardio-selective, which may have obscured the benefit of pan-selective beta-blockers in this meta-analysis.

 

Conclusion:

Our findings do not demonstrate a survival advantage for beta-blocker use in cutaneous melanoma. However, there is preliminary evidence that pan-selective beta-blockers specifically may be protective, and this should be investigated via randomised controlled trials. Future prognostic studies should delineate exposure by beta-blocker type and consider adjustments for competing risks and immortal time bias if applicable.