ideasIdea
Cheap perioperative beta-blocker plus anti-inflammatory to blunt surgical stress
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.
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.
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.
What would test it
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
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
6
Bottlenecks it attacks
- Metastasis is understood least and studied last · Metastasis causes about nine in ten cancer deaths but gets a small fraction of research money and almost no trials of its own.
- No incentive to repurpose cheap drugs · Old, cheap drugs with anti-cancer signals never get the trials they need because no one profits from the result.