# Cheap perioperative beta-blocker plus anti-inflammatory to blunt surgical stress

Source: https://onco.cc/ideas/idea-bio2-perioperative-betablocker-nsaid/  
OnCo record `idea-bio2-perioperative-betablocker-nsaid` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The stress of an operation may help stray cancer cells survive and settle. A few days of two cheap old drugs around surgery might reduce that risk.

## Summary

Propranolol plus a COX-2 inhibitor given for days around surgery reduced pro-metastatic molecular signatures in randomised biomarker trials in breast and colorectal cancer, and observational series suggest lower recurrence. No commercial sponsor exists because both drugs are generic, so a publicly funded pragmatic trial is the only route to an answer.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Five to eleven days of perioperative propranolol plus an NSAID improves three-year distant disease-free survival by an absolute 3-5% after resection of colorectal or breast cancer, without excess surgical complications.
- Rationale: Catecholamine and prostaglandin signalling drive immune suppression, epithelial-mesenchymal transition and vascular permeability in the perioperative window. The intervention is short, cheap and already pre-validated in humans at the transcriptomic level.
- Proposed test: A registry-embedded pragmatic randomised trial of about 3,000 resections across national surgical networks, using day-28 ctDNA as an intermediate endpoint for an early signal.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Metastasis is understood least and studied last): Dillekås et al., Are 90% of deaths from cancer caused by metastases? (Cancer Medicine 2019): https://doi.org/10.1002/cam4.2474

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- technologies: [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- pathways: [Epithelial-mesenchymal transition & drug efflux](https://onco.cc/pathways/emt/)
- bottlenecks: [Metastasis is understood least and studied last](https://onco.cc/bottlenecks/b-metastasis-biology/), [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/)
- key papers: [Are 90% of deaths from cancer caused by metastases?](https://onco.cc/key-papers/paper-dillekas-cancer-med/)

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