Statins

Also known by these names

  • HMG-CoA reductase inhibitors
  • Generic and brand names available in the US:
    • Atorvastatin (Lipitor)
    • Pitavastatin (Livalo)
    • Fluvastatin (Lescol, Lescol XL)
    • Lovastatin (Mevacor, Altoprev)
    • Simvastatin (Zocor)
    • Pravastatin (Pravachol)
    • Rosuvastatin (Crestor)

Key Points

  • Statins are a class of drugs approved by the FDA for several diseases and conditions.
  • Use of statins in cancer prevention or treatment is considered “off-label.”
  • Most of the evidence of statin use in cancer is from lab and animal studies and observational studies in humans. There are very few human clinical trials of statin use in cancer.
  • Most researchers advise that more research is necessary to determine dosage, formulation, effectiveness and safety for use in cancer.
  • BCCT's interest in statins derives from laboratory and clinical effects of statins in cancer, including anticancer effects such anti-proliferation, anti-angiogenesis and apoptosis, and also increasing cancer susceptibility to conventional treatment.
  • Certain statins show promise in cancer prevention and treatment.
  • Statins as approved for treating high cholesterol and are generally safe and usable long-term, although several cautions, potential side effects and interactions are noted.
  • Serious side effects include permanent muscle damage and impaired cognitive function.
  • Potential benefits in cancer must be weighed against the risks, and they should be discontinued promptly if serious side effects occur.
  • Use statins under the supervision of a medical doctor who is experienced in prescribing and monitoring statins, particularly in patients with cancer.
  • Some classes of statins may be more useful in cancer, or come with fewer serious side effects than others.
  • Some integrative oncologists who use statins off-label also prescribe supplements—such as coenzyme Q10—to reduce the risk of muscle damage.

Statins are a class of cholesterol-lowering drugs being used off-label for cancer treatment by some integrative oncologists. Off-label use is a drug’s application for a disease or condition that has not yet received FDA approval. Every US state allows for drugs to be used off-label as long as there is enough evidence to support its use.

Statins are sub-classified as either more hydrophilic (attract or associate with water molecules, possessed by polar radicals or ions) or more lipophilic (able to dissolve or attach to lipids).

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Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

Clinical Evidence

General or Unspecified Cancers

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Breast Cancer

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Colorectal Cancer

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Gynecologic Cancer

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Hepatocellular Carcinoma

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Lung Cancer

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Melanoma

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Non-Hodgkin’s Lymphoma

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Pancreatic Cancer

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Prostate Cancer

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Kidney Cancer

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Clinical Trials

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Modes of Action

Many observational and preclinical studies point to anticancer characteristics of statins:

  • Inhibiting tumor growth
  • Promoting programmed cell death
  • Preventing the development of new blood vessels
  • Preventing metastasis

All these processes play an important role in cancer causation, leading to oncologists’ interest in the role of statins in cancer prevention and treatment.30

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Lab and Animal Evidence

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Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Clinical Evidence

A 2017 review found that statins reduced anthracycline-induced cardiotoxicity in humans:43

  • Breast cancer patients receiving statins during anthracycline therapy had a lower risk of heart failure.
  • Statins were at least equally potent as dexrazoxane, beta-blockers or angiotensin antagonists in preventing anthracycline-induced cardiotoxicity.
  • Two small studies reported no change in left ventricular ejection fraction (LVEF) among patients receiving either high doses of atorvastatin or any statin during chemotherapy with doxorubicin or idarubicin for up to six months. Patients that did not receive the statin showed a significant decrease in LVEF.

Lab and Animal Evidence

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Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Statin use reduced breast cancer risk in some but not all studies.46 Decreased five-year breast cancer recurrence rates were found with initiatiion of statins less than three years after diagnosis of early stage breast cancer with lipophilic statins but not hydrophilic statins.47

A 2018 review and meta-analysis found a reduced liver cancer risk in the general population with statin intake.48

Evidence, mostly from lab, animal and observational studies, indicates statins are useful in preventing several other cancers. In most of the human observational studies, statins were already being used by patients to lower cholesterol and to prevent heart disease. “Current evidence cannot exclude a modest decrease in the risk of developing colorectal cancer, a lower risk of advanced/aggressive prostate cancer and even larger risk reductions for certain cancer types (such as gastric, oesophageal or hepatocellular) associated with statin use.”49 In a large study in 2019, statin use was associated with a lower risk of postcolonoscopy colorectal cancer, particularly for cancer in the lower colon.50

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Barrett’s Esophagus and Esophageal Carcinoma

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Brain Cancer

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Breast Cancer

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Colorectal Cancer

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Gastric Cancer

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Gynecologic Cancer (Endometrial and Ovarian)

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Hepatocellular Carcinoma

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Kidney Cancer

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Lung Cancer

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Melanoma

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Non-Hodgkin’s Lymphoma

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Pancreatic Cancer

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Prostate Cancer

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Access

Statins oral form are available with a prescription at pharmacies. The dose and formulation varies by the specific statin prescribed. Some, such as lovastatin, are available in extended-release formulation.

Cautions

Some evidence indicates that statins may increase cancer risk in elderly patients, especially in association with hydrophilic statin use.86 A 2014 review concluded that “recent meta-analysis, however, showed no evidence of cancer increment in statin-treated elderly participants.”87 Some evidence indicates they may induce resistance to chemotherapy.88

Common Side Effects/Adverse Events

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Statins and Drug or Food Interactions

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Contraindications

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Dosing

BCCT does not recommend therapies or doses, but only provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated.

Dosing of statins in conventional use varies depending on the particular statin prescribed.

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Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.
  • Programs and protocols

Commentary

Regarding concern for cognitive dysfunction with statin use, Gary Oberlender, MD, a geriatrician and consultant in geriatric care states: “Though the connection between statins and cognitive dysfunction has not been ‘proven’, that does not prove a lack of connection. The studies published have been too short and not well performed, in my view. However, there is abundant anecdotal evidence, including my own [clinical] experience, that strongly suggests that some, but certainly not all, people who take statins experience brain fog or other ill-defined cognitive symptoms. I think it has to do with too low LDL levels. In any event, I routinely recommend stopping statin drugs in persons experiencing cognitive symptoms, but only after a discussion with their primary care provider. I am not aware of evidence linking statin use with improved cognitive performance, though statins may reduce the risk of vascular dementia.”107

Integrative oncologist and BCCT advisor Keith Block, MD: “Because statins deplete coenzyme Q10 especially from your muscle cells, particularly your heart, I advise patients on statins to take at least 30 mg of coQ10 per day, and 200 mg or considerably more if they are taking any heart-damaging medications such as Adriamycin or Herceptin.”108

Uses of Statins Off-Label for Cancer

What some researchers and clinicians are saying:

Integrative oncologist and BCCT advisor Keith Block, MD, wrote in his 2009 book: “A 2007 trial suggested that a statin may overcome drug resistance in multiple myeloma. So if a patient has multiple myeloma and is out of options, I would certainly consider as one option prescribing a statin for her alongside her drug protocol, in hopes of overcoming resistance and initiating a response.”109

Raymond Chang, MD, FACP, medical director of the Meridian Medical Group, writes: “Based on the large volume of research, the benefits of statin use appear to outweigh the potential risks. Still, patients should discuss statin use with a healthcare professional and take the drug only as directed.“110

Pon et al. in a 2015 review: “If statin use is warranted for another indication, prolonged use, especially with a potent statin, may potentially decrease the risk of advanced prostate cancer or mortality associated with prostate cancer.”111

Henninger and Fritz: “Off-label use of statins or novel Rac1 inhibitors might represent a promising pharmacological approach to gain control over chronic cardiotoxicity by interfering with key mechanisms of anthracycline-induced cardiomyocyte cell death.”112

Wang et al.: “Studies seem to suggest that statins may be protective and are not likely to be harmful in the setting of cancer, suggesting that cancer patients who already take statins should not have this medication discontinued.”113

Non-cancer Uses of Statins

Statins are a class of drugs that lower the level of cholesterol in the blood by reducing the production of cholesterol by the liver. Statins block the enzyme in the liver that is responsible for making cholesterol. They are also used to prevent and treat atherosclerosis.114

Statins are one of the most commonly prescribed drugs in the US to reduce the risk of strokes, heart attacks and cholesterol levels. In addition to cancer, statins use is also being researched in these conditions:115

  • Autoimmune disorders
  • Cataracts
  • Dementia
  • Emphysema
  • Osteoporosis
  • Sepsis
  • Various cardiovascular conditions

BCCT has not reviewed the effectiveness of this therapy for non-cancer uses.

Integrative oncologist and BCCT advisor Dwight McKee, MD, among others, concludes that “because most of the statins have patents that are expired or near expiration, there is a lack of incentive on the part of drug companies to conduct large scale clinical trials using these agents against cancer, so it is not clear that we will gain much more useful clinical insight in the near future, but strong reasons to consider adding statins to most cancer preventative or treatment cocktails unless side-effects are an issue in an individual patient.

“Notwithstanding occasional contradictory reports of statins increasing the risk of cancer, given the safety (simvastatin is available as an OTC in the U.K.) and low cost of statins, plus the wide array of studies and accumulating data showing a protective effect of statins against cancer development and recurrence, statins should be seriously considered as part of a cocktailed approach for primary and secondary cancer prevention (especially for colon, breast, lung and prostate—where the data are strongest).

“Statins should also be seriously considered as a cornerstone ingredient to combine synergistically with other compounds such as gamma tocotrienols, cox-2 inhibitors, bisphosphonates etc for added effects in cancer treatment. Not all statins are the same however, and some (e.g. lipophilic statins such as simvastatin) may work better against certain cancers than others (e.g. hydrophilic statins such as pravastatin). Dosage may be important as well.”116

Written by Laura Pole, RN, MSN, OCNS, and reviewed by Nancy Hepp, MS; most recent update June 19, 2019.

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