Statins in the context of precision cancer medicine: important factors to consider

Statins, commonly prescribed for hypercholesterolemia, have demonstrated a range of anticancer properties, including the induction of apoptosis and ferroptosis, modulation of autophagy, and reprogramming of the tumor microenvironment. These effects position statins as promising candidates for drug repurposing in oncology. However, integrating statins into cancer care will require a precision medicine approach. Despite the increasing volume of preclinical data supporting statin anticancer effects, clinical evaluation remains limited. To date, only a small number of clinical trials have investigated statins in oncology, and these have primarily focused on moderate-intensity regimens. Emerging evidence suggests that certain statins may be more effective than others as anticancer agents, with their therapeutic activity shown to be both dose- and time-dependent. This review highlights key considerations for formulating a precision cancer medicine framework for statins. These include the chemical properties and pharmacokinetics of different statins, interpatient genetic variability affecting statin response, biomarkers of statin sensitivity, the need to achieve therapeutically relevant concentrations in tumor tissue, potential synergies with existing chemotherapeutic agents, and recent advances in targeted statin delivery technologies.