title: Improving survival rates in two models of spontaneous postoperative metastasis in mice by combined administration of a beta-adrenergic antagonist and a cyclooxygenase-2 inhibitor.
abstract: Clinical practice does not consider perioperative paracrine and neuroendocrine stress responses as risk factors for cancer recurrence, although recent animal studies provided supportive evidence. Suggested mechanisms include the effects of stress-hormones on tumor cells and on host physiology. In this study, in mice undergoing primary tumor excision, we tested the survival-enhancing potential of perioperative blockade of catecholamines and prostaglandins, and studied potential mediating mechanisms. C57BL/6J mice were inoculated intrafootpad with syngeneic B16F10.9-melanoma or Lewis lung carcinoma, and the paw was amputated when a developing tumor exceeded 100 microl. The clinically used beta-adrenergic antagonist propranolol, and/or the cyclooxygenase-2 inhibitor etodolac, were administered once before amputation, and recurrence-free survival was monitored. In different studies, NK cytotoxicity, leukocytes' molecular functional markers, and vascular endothelial growth factor secretion by tumor cells were studied in the context of surgery and drug treatments. The findings indicated that the combination of propranolol and etodolac, but neither drug alone, significantly and markedly improved survival rates in both tumor models, and was as effective as established immunostimulatory agents (IL-12 and polyinosinic-polycytiylic acid). Surgery markedly reduced NK cytotoxicity and NK cell expression of Fas ligand and CD11a, reduced all circulating lymphocyte-subtype concentrations, and increased corticosterone levels. Propranolol and etodolac administration counteracted these perturbations. B16 and 3LL secreted vascular endothelial growth factor in vitro, but secretion was not affected by catecholamine agonists, prostaglandins, corticosterone, propranolol, or etodolac. Overall, propranolol and etodolac administration, which could be applied perioperatively in most cancer patients with minimal risk and low cost, has counteracted several immunologic and endocrinologic perturbations and improved recurrence-free survival rates in mice undergoing primary tumor excision.
authors.affiliation: Neuroimmunology Research Unit, Department of Psychology, Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: Ariella
authors.initials: A
authors.lastname: Glasner
authors.forename: Roi
authors.initials: R
authors.lastname: Avraham
authors.forename: Ella
authors.initials: E
authors.lastname: Rosenne
authors.forename: Marganit
authors.initials: M
authors.lastname: Benish
authors.forename: Oded
authors.initials: O
authors.lastname: Zmora
authors.forename: Shaily
authors.initials: S
authors.lastname: Shemer
authors.forename: Hadas
authors.initials: H
authors.lastname: Meiboom
authors.forename: Shamgar
authors.initials: S
authors.lastname: Ben-Eliyahu
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000671:Amputation, Surgical / Q000009:adverse effects; D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D040881:CD11a Antigen / Q000378:metabolism; D018827:Carcinoma, Lewis Lung / Q000473:pathology / Q000601:surgery*; D045744:Cell Line, Tumor; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage; D017308:Etodolac / Q000008:administration & dosage; D053222:Fas Ligand Protein / Q000378:metabolism; D005260:Female; D018664:Interleukin-12 / Q000008:administration & dosage; D007694:Killer Cells, Natural / Q000187:drug effects / Q000276:immunology / Q000378:metabolism; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D008546:Melanoma, Experimental / Q000473:pathology / Q000601:surgery*; D051379:Mice; D008810:Mice, Inbred C57BL; D009362:Neoplasm Metastasis; D011070:Poly I-C / Q000008:administration & dosage; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011433:Propranolol / Q000008:administration & dosage; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists; D040881:CD11a Antigen; D052246:Cyclooxygenase 2 Inhibitors; D053222:Fas Ligand Protein; C505658:Fasl protein, mouse; D018664:Interleukin-12; D017308:Etodolac; D011433:Propranolol; D011070:Poly I-C