# Cut the nerve supply to tumours with old drugs

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

## TL;DR

Nerves feed pancreatic, prostate, and other tumours. Beta-blockers and botulinum toxin are cheap, safe, and already in trials to see if severing that link slows cancer.

## Summary

This idea proposes cutting the nerve supply to tumours with old drugs: nerves feed pancreatic, prostate and other tumours, and beta-blockers and botulinum toxin are cheap, safe and in trials. Propranolol reduced proliferation markers in window trials, denervation slowed gastric cancer in mice, perampanel targets glioma synapses, and perineural invasion is strongly prognostic. The hypothesis, rooted in the Cancer neuroscience pathway, is that beta-blockade or denervation added to standard therapy improves outcomes in tumours with high perineural invasion or an adrenergic signature. The tests are a randomised phase 2 of propranolol in resectable Pancreatic ductal adenocarcinoma and a perampanel trial in Glioma & glioblastoma; Prostate cancer is also in scope.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Tags: mechanism; open-question
- Hypothesis: Adding β-blockade (or local denervation) to standard therapy improves outcomes in tumours with high perineural invasion or adrenergic signature.
- Rationale: Strong preclinical mechanism (Monje, Amit, Zahalka), epidemiologic signals for β-blocker users, low cost and toxicity.
- Proposed test: Randomised phase 2 of propranolol vs placebo added to standard therapy in resectable pancreatic cancer with perineural invasion, endpoint DFS; glioma trial of perampanel plus standard therapy with growth-rate endpoint.
- Maturity: early-clinical

## Sources

- Zahalka et al., Adrenergic nerves activate an angio-metabolic switch in prostate cancer (Science 2017): https://doi.org/10.1126/science.aah5072

## Connected records

- cancers: [Glioma & glioblastoma](https://onco.cc/cancers/glioblastoma/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- institutions: [MD Anderson Cancer Center](https://onco.cc/institutions/md-anderson/), [Memorial Sloan Kettering Cancer Center](https://onco.cc/institutions/mskcc/), [Stanford Health Care / Stanford Cancer Institute](https://onco.cc/institutions/stanford/)
- pathways: [Cancer neuroscience (nerve-tumour signalling)](https://onco.cc/pathways/cancer-neuroscience/)
- key papers: [Adrenergic nerves activate an angio-metabolic switch in prostate cancer](https://onco.cc/key-papers/paper-zahalka-science/)

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