Reduction of breast cancer relapses with perioperative non-steroidal anti-inflammatory drugs

New findings and a review

Michael Retsky* (Corresponding Author), Romano Demicheli, William J. M. Hrushesky, Patrice Forget, Marc De Kock, Isaac Gukas, Rick A. Rogers, Michael Baum, Vikas Sukhatme, Jayant S. Vaidya

*Corresponding author for this work

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

To explain a bimodal pattern of hazard of relapse among early stage breast cancer patients identified in multiple databases, we proposed that late relapses result from steady stochastic progressions from single dormant malignant cells to avascular micrometastases and then on to growing deposits. However in order to explain early relapses, we had to postulate that something happens at about the time of surgery to provoke sudden exits from dormant phases to active growth and then to detection. Most relapses in breast cancer are in the early category. Recent data from Forget et al. suggest an unexpected mechanism. They retrospectively studied results from 327 consecutive breast cancer patients comparing various perioperative analgesics and anesthetics in one Belgian hospital and one surgeon. Patients were treated with mastectomy and conventional adjuvant therapy. Relapse hazard updated Sept 2011 are presented. A common Non-Steroidal Anti-Inflammatory Drug (NSAID) analgesic used in surgery produced far superior disease-free survival in the first 5 years after surgery. The expected prominent early relapse events in months 9-18 are reduced 5-fold. If this observation holds up to further scrutiny, it could mean that the simple use of this safe, inexpensive and effective anti-inflammatory agent at surgery might eliminate early relapses. Transient systemic inflammation accompanying surgery could facilitate angiogenesis of dormant micrometastases, proliferation of dormant single cells, and seeding of circulating cancer stem cells (perhaps in part released from bone marrow) resulting in early relapse and could have been effectively blocked by the perioperative anti-inflammatory agent.
Original languageEnglish
Pages (from-to)4163 - 4176
Number of pages14
JournalClinical Breast Cancer
Volume20
Issue number33
DOIs
Publication statusPublished - 2013

Fingerprint

Anti-Inflammatory Agents
Breast Neoplasms
Recurrence
Pharmaceutical Preparations
Neoplasm Micrometastasis
Neoplastic Stem Cells
Mastectomy
Non-Steroidal Anti-Inflammatory Agents
Disease-Free Survival
Analgesics
Anesthetics
Bone Marrow
Databases
Inflammation
Growth

Keywords

  • Breast cancer
  • early relapse
  • late relapse
  • angiogenesis
  • inflammation
  • surgery
  • analgesic
  • perioperative
  • metastases
  • bleeding
  • NSAID
  • dormancy

Cite this

Reduction of breast cancer relapses with perioperative non-steroidal anti-inflammatory drugs : New findings and a review. / Retsky, Michael (Corresponding Author); Demicheli, Romano; Hrushesky, William J. M.; Forget, Patrice; De Kock, Marc; Gukas, Isaac; Rogers, Rick A.; Baum, Michael; Sukhatme, Vikas; Vaidya, Jayant S.

In: Clinical Breast Cancer, Vol. 20, No. 33, 2013, p. 4163 - 4176.

Research output: Contribution to journalArticle

Retsky, M, Demicheli, R, Hrushesky, WJM, Forget, P, De Kock, M, Gukas, I, Rogers, RA, Baum, M, Sukhatme, V & Vaidya, JS 2013, 'Reduction of breast cancer relapses with perioperative non-steroidal anti-inflammatory drugs: New findings and a review', Clinical Breast Cancer, vol. 20, no. 33, pp. 4163 - 4176. https://doi.org/10.2174/09298673113209990250
Retsky, Michael ; Demicheli, Romano ; Hrushesky, William J. M. ; Forget, Patrice ; De Kock, Marc ; Gukas, Isaac ; Rogers, Rick A. ; Baum, Michael ; Sukhatme, Vikas ; Vaidya, Jayant S. / Reduction of breast cancer relapses with perioperative non-steroidal anti-inflammatory drugs : New findings and a review. In: Clinical Breast Cancer. 2013 ; Vol. 20, No. 33. pp. 4163 - 4176.
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AU - Forget, Patrice

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AU - Baum, Michael

AU - Sukhatme, Vikas

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