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February 25-26, 2019 | Paris, France
13
th
World Cancer Congress
Journal of Medical Oncology and Therapeutics | Volume 4
Perioperative use of NSAID might prevent early relapses in Breast and other Cancers
Michael W Retsky
Harvard TH Chan School of Public Health, USA
A
bimodal pattern of hazard of relapse among early stage
breast cancer patients has been identified in multiple
databases from US, Europe and Asia. My colleagues and I
have been studying these data to determine if this can lead to
new ideas on how to prevent relapse in breast cancer. Using
computer simulation and access to a very high quality database
from Milan for patients treated with mastectomy only, we
proposed that relapses within 3 years of surgery are stimulated
somehow by the surgical procedure. Most relapses in breast
cancer are in this early category. Retrospective data from a
Brussels anesthesiology group suggests a plausible mechanism.
Use of ketorolac, a common NSAID analgesic used in surgery
was associated with 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. Transient systemic
inflammationaccompanyingsurgery (identifiedby IL-6 inserum)
could facilitate angiogenesis of dormant micrometastases,
proliferation of dormant single cells, and seeding of circulating
cancer cells resulting in early relapse and could have been
effectively blocked by the perioperative anti-inflammatory
agent. 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. We suggest this would be most effective for triple
negative breast cancer and be especially valuable in low and
middle income countries. Similar bimodal patterns have been
identified in other cancers suggesting a general effect. There are
now two retrospective studies (Forget et al 2010 and Desmedt
et al 2018) and an animal model (Krall et al 2018) supporting
this hypothesis but a prospective clinical trial is still needed. We
are interested in conducting a prospective clinical trial for TNBC
at Harvard. We think it will reduce relapse and mortality by 25
to 50% at low cost and toxicity. Use of tranexamic acid may
reduce post-operative bleeding. Video is presented.
Speaker Biography
Michael Retsky (PhD in Physics fromUniversity of Chicago) made a career change to cancer
research thirty years ago. He was on Judah Folkman’s staff at Harvard Medical School for
12 years. Diagnosed with stage IIIc colon cancer in 1994, he opted for a low dose long term
chemotherapy protocol that is now called metronomic chemotherapy. Retsky is Editor and
Romano Demicheli is Co-Editor of a Springer/Nature book on breast cancer published in
July 2017. Retsky is a founder of the Colon Cancer Alliance and has published more than 90
papers in physics and cancer.
e:
michael.retsky@gmail.com