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NSAID analgesic ketorolac used perioperatively may suppress early breast cancer relapse: particular relevance to triple negative subgroup

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Retsky_NSAIDAnalgesic.pdf (1.12 MB)

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2012

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10.1007/s10549-012-2094-5

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Springer
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Retsky, Michael, Rick Rogers, Romano Demicheli, William J. M. Hrushesky, Isaac Gukas, Jayant S. Vaidya, Michael Baum, et al. Forthcoming. NSAID analgesic ketorolac used perioperatively may suppress early breast cancer relapse: particular relevance to triple negative subgroup. Breast Cancer Research and Treatment.

Abstract

To explain a bimodal relapse hazard among early stage breast cancer patients treated by mastectomy we postulated that relapses within 4 years of surgery resulted from something that happened at about the time of surgery to provoke sudden exits from dormant phases to active growth. Relapses at 10 months appeared to be surgery-induced angiogenesis of dormant avascular micrometastases. Another relapse mode with peak about 30 months corresponded to sudden growth from a single cell. Late relapses were not synchronized to surgery. This hypothesis could explain a wide variety of breast cancer observations. We have been looking for new data that might provide more insight concerning the various relapse modes. Retrospective data reported in June 2010 study of 327 consecutive patients compared various perioperative analgesics and anesthetics in one Belgian hospital and one surgeon. Patients were treated with mastectomy and conventional adjuvant therapy. Follow-up was average 27.3 months with range 13–44 months. Updated hazard as of September 2011 for this series is now presented. NSAID ketorolac, a common analgesic used in surgery, is associated with far superior disease-free survival in the first few years after surgery. The expected prominent early relapse events are all but absent. In the 9–18 month period, there is fivefold reduction in relapses. If this observation holds up to further scrutiny, it could mean that the simple use of this safe and effective anti-inflammatory agent at surgery might eliminate most early relapses. Transient systemic inflammation accompanying surgery could be part of the metastatic tumor seeding process and could have been effectively blocked by perioperative anti-inflammatory agents. In addition, antiangiogenic properties of NSAIDs could also play a role. Triple negative breast cancer may be the ideal group with which to test perioperative ketorolac to prevent early relapses.

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early relapse, analgesia, ketorolac, inflammation, NSAID, triple negative breast cancer, computer simulation

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http://nrs.harvard.edu/urn-3:HUL.InstRepos:8923700

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NSAID analgesic ketorolac used perioperatively may… : DASH Story 2014-11-17
I am a patient with history of breast cancer, I learned about early recurrence of breast cancer for the first time Nov 13 2014 from Dr Retsky's research on how Ketorolac NSAID may suppress early recurrence of breast cancer via open access , digital access DA at Harvard U . The day I found this website, I benefited personally immediately from it. It was the first postop day after my prophylactic second mastectomy I decided to have because my mother had breast cancer and it returned very soon in her other breast as a second primary I was told by the family. I could not corroborate that this was indeed a second primary in the contrary breast or possible it was an early occurrence of the first primary described in this article by Dr Retsky . I could not use my mothers chart because it had been given to a breast cancer research facility near my sisters home and when we asked to look back at those records, we found out that the agency had thrown out my mothers records ( without consent from our family) . The benefit of finding Dr Resky's research with my computer using a portable smart phone at the hotel were I was recuperating, I immediately decided not to use any more narcotics and I was motivated to use the 12 hour po Diclofenac which is similar to Ketorolac. Staff did instruct me to use this medication with food and watch for stomach pain but I was not told the rationale of why this pain management was used and the same institution was recommending narcotics and switch to Tylenol during my first mastectomy for an ER +ductal cancer in December 2013. In making my decision to have a second prophylactic mastectomy I was told there was the usual possible sideeffects to undergo any surgery but nobody discussed the evidence that the stress of surgery may be stimulating microbal cancer cells to become active and cause an early metastasis. Surgeons are however complaining that patients are asking for that second prophylactic surgery but they have not discussed the risk of the surgery itself in the many articles that I read prior to forming my decision to go ahead with the prophylactic mastectomy. I am currently very happy with my second surgery that was very successful and I have no regrets to have it done and I am especially pleased that Diclofenac was used during or after the operation but I sure expected to be informed about this new discovery which made me more motivated to switch off narcotics immediately the first day and and get with NSAID analgesics-- which worked just fine in controlling the post op pain. Thank you for posting the entire article not just the abstract, it was most informative and worth while to me and I will do my best to pass it on to other patients who may also benefit from this.