Potential Harm of Ativan for Pancreatic Cancer Patients

Potential Harm of Ativan for Pancreatic Cancer Patients

The Impact of Benzodiazepines on Pancreatic Cancer Outcomes


Sometimes patients with pancreatic cancer are prescribed benzodiazepines to alleviate anxiety. However, a recent study has shown that this treatment may have detrimental effects on their health. The use of the benzodiazepine lorazepam (Ativan) was found to be associated with shorter survival times and faster disease progression. Conversely, patients who took alprazolam (Xanax) had significantly longer progression-free survival compared to those who did not.

The Influence of Palliative Care Drugs on Tumors

“When we study response to therapy, we think of treatments like chemotherapy or immunotherapy, but patients are also given a lot of medicines for anxiety and pain,” explains senior study author Michael Feigin, an associate professor of pharmacology and therapeutics at Roswell Park Comprehensive Cancer Center in New York. “We wanted to understand the impact of some of these palliative care drugs on the tumor.”

Benzodiazepines are commonly prescribed to cancer patients to alleviate anxiety, insomnia, and seizures by suppressing the central nervous system. However, their potential impact on tumor growth and outcomes has not been thoroughly explored.

Examining Benzodiazepine Use in Cancer Treatment

To investigate the impact of benzodiazepines on cancer treatment, researchers evaluated the prevalence of benzodiazepine use among patients treated at Roswell Park for various types of cancer. Among the patients, nearly 31% received benzodiazepines, with pancreatic cancer patients having the highest rate of benzodiazepine use at 41%.

Adjusting for other factors, benzodiazepine use was associated with a 30% lower risk of pancreatic cancer-related death. However, a closer look at specific benzodiazepines revealed contrasting outcomes for pancreatic cancer patients.

Contrasting Outcomes of Different Benzodiazepines

The two most commonly prescribed benzodiazepines were lorazepam (Ativan) and alprazolam (Xanax). Patients taking Xanax had a 62% lower risk of disease progression or death compared to those who did not take the drug. On the other hand, patients taking Ativan had a nearly fourfold higher risk of disease progression or death.

Furthermore, Ativan was correlated with significantly worse overall survival in other cancer types as well, including prostate, ovarian, head and neck, uterine, colon, breast, and melanoma. The increased risk ranged from 25% to 116%.

Potential Mechanisms at Play

To understand the impact of benzodiazepines on the tumor microenvironment, researchers conducted tests on mice. They found that lorazepam may activate a protein called GPR68, which is highly expressed on fibroblasts that support the tumor. Activation of GPR68 leads to increased expression of the cytokine IL-6, promoting inflammation in the pancreatic tumor microenvironment and contributing to increased tumor growth.

However, only a specific class of benzodiazepines, known as n-unsubstituted benzodiazepines (including lorazepam), could activate GPR68. N-substituted benzodiazepines, such as alprazolam, diazepam (Valium), and temazepam (Restoril), had no effect on GPR68 activation.

More research is needed to understand the underlying mechanism and clinical implications fully. While the study provides valuable insights, it is premature to recommend patients stop taking one drug or switch to another. Clinical trials would offer a more definitive evaluation.

Implications and Future Directions

The findings of this study highlight the importance of considering the potential impact of palliative care drugs, such as benzodiazepines, on cancer outcomes. It expands the scope of therapeutic interventions beyond chemotherapy and immunotherapy.

By understanding the specific mechanisms through which different benzodiazepines influence tumor growth, researchers can explore potential avenues for improving patient outcomes. Targeting specific benzodiazepines that have more favorable effects, like alprazolam, may lead to better treatment strategies for pancreatic cancer and other cancer types.

It is crucial for healthcare professionals to consider the holistic approach to patient care, taking into account the impact of all prescribed medications. This study opens up a new dimension in the field of cancer therapy, emphasizing the need for further research and clinical trials to confirm and build upon these findings.