Objective:

We investigated whether the use of beta-blockers (BB) for cardiovascular disease (CVD) yields progression free survival (PFS) and overall survival (OS) benefit in glioblastoma (GBM) patients.

Background:

Patients are prescribed BB to manage CVD. Proposed BB benefits in GBM include antagonism of tumor-induced sympathetic hyperactivity, believed to enhance tumor cell proliferation. Understanding survival metrics of GBM cohorts taking BB may clarify whether BB confers survival benefits. 

Design/Methods:

Single institution retrospective review yielded 523 patients diagnosed with GBM; 119 were prescribed BB outpatient while receiving treatment for their GBM. Acute disease management with BB was excluded. CVD included hypertension, cerebrovascular disease, arrythmias, or congestive heart failure. Kaplan Meier modeling characterized OS and PFS. Multivariable Cox proportional hazard models assessed survival for patients with (119) and without BB (404), corrected for age, sex, race, chemotherapy, radiotherapy, and surgery.

Results:

GBM patients taking BB displayed lower median PFS and OS (4.4 vs. 6.3 months; 8.1 vs. 13.2 months, respectively), increased risk of progression (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.2-1.8; p<0.001), and death (HR, 1.5; 95% CI, 1.2-1.9; p<0.001) compared to those not taking BB. Increased risk of death in GBM patients was also associated with CVD (HR, 1.7; 95% CI, 1.4-2.0, p<0.001) and higher age (HR, 1.03; 95% CI, 1.02-1.04; p<0.001). Within the CVD cohort, GBM patients taking BB demonstrated rapid progression (HR, 1.2; 95% CI, 0.97-1.6; p<0.10), death (HR, 1.2; 95% CI, 0.96-1.6; p<0.10), and worse median OS (7.5 vs. 9.2 months) than those with CVD but not taking BB. 

Conclusions:

CVD is associated with risk of progression and shorter survival in GBM patients. However, the hypothesized benefit of BB use on GBM survival was not replicated in either the full GBM cohort or within the CVD subset.