Perioperative Anti-inflammatory, Antistress Drugs May Reduce Postsurgical Metastatic Disease Recurrence


Key Points

  • 38 patients with breast cancer were given a pharmacologic treatment—a beta blocker, propranolol hydrochloride, and a nonsteroidal anti-inflammatory drug, etodolac—5 days before their surgeries, the day of their surgeries, and 5 days after their surgeries.
  • The drugs were very efficient in reducing biomarkers of metastatic processes.
  • The drug treatment reversed epithelial–mesenchymal transition and was able to improve immune competence and reduce inflammation.

Most cancer-related deaths are the result of postsurgical metastatic recurrence. A new Tel Aviv University (TAU) study published by Shaashua et al in Clinical Cancer Research found a specific drug regimen administered prior to and after surgery significantly reduces the risk of postsurgical cancer recurrence. These medications, a combination of a beta blocker and an anti-inflammatory agent, may also improve the long-term survival rates of patients. The treatment is safe, inexpensive (two medications similar in price to aspirin), and easily administered to patients without contraindications.

Unconventional Approach

“We've taken an unconventional approach, deviating from the current medical dogma that refrains from intervening during the short period surrounding a cancer surgery—no chemo[therapy], radio[therapy], or immune therapy for at least 3 weeks before or after surgery,” said senior study author Shamgar Ben-Eliyahu, PhD, of TAU's School of Psychological Sciences and Sagol School of Neuroscience.

“Even within the medical establishment, we encountered some levels of disbelief and antagonism,” he continued. “But after conducting ample studies in animal models of cancer, and reviewing the medical literature, we came to the firm conclusion that maybe this is the most important period in the prevention of cancer recurrence.”

Study Findings

For the study, 38 patients with breast cancer at Sheba Medical Center, Kaplan Medical Center, and Rabin Medical Center were given a pharmacologic treatment—the beta blocker propranolol hydrochloride (used to reduce blood pressure and anxiety) and a nonsteroidal anti-inflammatory drug, etodolac (used to reduce inflammation)—5 days before their surgeries, the day of their surgeries, and 5 days after their surgeries. Blood and tumor tissue samples were then analyzed using whole-genome gene-expression profiling to identify all the RNAs expressed in malignant cells and leukocytes.

“We found that the drugs were very efficient in reducing biomarkers of metastatic processes,” Dr. Ben-Eliyahu said. “For example, we found that the drug treatment reverses epithelial–mesenchymal transition—the process that tumor cells go through to slip out of the primary tumor and enter another organ. It is a crucially important step in the metastatic process. We also looked at indices related to the immune system and were able to improve immune competence and reduce inflammation with the drugs.”

The research team has conducted a similar study, which has not yet been published, in patients with colorectal cancer and has found similar results.

The researchers are currently considering a larger-scale clinical trial to establish the clinical long-term beneficial effects of this treatment. “Positive outcomes should validate this treatment and lead to its becoming available for most cancer patients,” Dr. Ben-Eliyahu concluded.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.