Can your medicines cause pancreatic cancer?

Zhang, Y., Wang, QL., Yuan, C. et al. Pancreatic cancer is associated with medication changes prior to clinical diagnosis. Nat Commun 14, 2437 (2023). https://doi.org/10.1038/s41467-023-38088-2

Pancreatic ductal adenocarcinoma (pancreatic cancer or PDAC) is the third leading cause of cancer-related death in the US, as it is difficult to treat and maintains short survival times. However, while detecting the cancer at the earliest instance is crucial, due to the rarity and relatively low disease incidence, average-risk general population screening is difficult. A study was performed in order to explore the relationship between changes in medication and the subsequent development of pancreatic cancer.

Let’s break it down. Simply put, this study is trying to convey that changing medications, such as starting antidiabetic or anticoagulant medications (medications that prevent blood clots) and stopping antihypertensive medications (used to treat high blood pressure), is associated with the development of pancreatic cancer.

Patients with PDAC commonly develop symptoms one or two years before diagnosis that might serve as early warning signs of malignancy. These newly developed conditions cause them to change medications, which is hypothesized to further prompt PDAC. For example, metabolic alterations such as weight loss commonly occur during this window before diagnosis and are increasingly recognized as factors defining a high-risk patient. The weight loss and metabolic derangements suffered by patients often manifest themselves as a reduction in blood pressure, which may reduce the need for antihypertensive medications, causing the change in medications. Furthermore, the risk of getting PDAC increases as the number of medication changes increases, showing a direct link between the two.

To examine medication changes in the two-year pre-diagnosis time period, patients were investigated to determine any correlation between medication change patterns and subsequent pancreatic cancer development. The initial hypothesis when beginning the investigation was that starting antidiabetic, anticoagulant, or antidepressant medications and stopping antihypertensive medications would be associated with an increased likelihood of pancreatic cancer development in the next 2 years. Those conducting the study also considered if these changes were specific to pancreatic cancer patients or whether they were more generally identified amongst patients diagnosed with cancer. However, it was found that the alteration in medications did not lead to other forms of digestive system or gastrointestinal cancers, rather it was mainly a cause of PDAC.

Analyses of anticoagulant medications, antihypertensive medications, and antidepressants were first conducted in a combined cohort of patients of both sexes. It was found that there were multiple incident pancreatic cancer cases amongst patients who changed their antidiabetic medication use. Given the relationship between newly developed hyperglycemia and pancreatic cancer, this is an understandable result. Furthermore, when considering the effect of change in the use of anticoagulant medication in both cohorts, it was found that there were numerous incident pancreatic cancer cases.

In conclusion, after exploring the association between medication change in the pre-diagnosis window and pancreatic cancer development, it was found that certain medications and alterations can in fact have a significant impact on the development of pancreatic cancer. This knowledge will enable doctors to treat patients suffering from certain conditions with alternative medications or allow them to simultaneously begin preventative treatments, hence lowering the risk of that patient developing pancreatic cancer. Bringing us closer to the verge of a breakthrough, this study shows potential for a way to avoid developing certain forms of cancer overall. It is a stepping stone for future discoveries.