Perioperative administration of propranolol to women undergoing ovarian cancer surgery: A pilot study

Abstract

ObjectiveThis study was done to evaluate whether perioperative propranolol (ß-blocker) in ovarian cancer patients undergoing debulking surgery reduced perioperative tumor growth induced by surgical stress.MethodsThis was a prospective randomized single institution analysis. The primary objective was to compare the changes in CA 125 level (changes between preoperation day 2 and postoperative day 7). As a study arm, patients received a low dose of propranolol 40 mg/day (4×10 mg) starting two days before surgery and 40 mg twice daily for three days following surgery.ResultsTwenty-two patients were enrolled and 16 were evaluable for efficacy. The drug was well tolerated. The mean decrease of CA 125 during the seven perioperative days was 83.1±8.9% in the propranolol group and 72.4±14.7% in the placebo group. The difference was statistically significant (P=0.044). The change of C-reactive protein, cortisol, and anxiety score (State-Trait Anxiety Inventory-X1) were not different between the two groups.ConclusionThis preliminary result is the first to directly test the role of perioperative propranolol on tumor growth. Even with the small sample size and short term use of the drug, perioperative propranolol was effective in reducing tumor burden (as measured by CA 125) suggesting its potential benefits in decreasing perioperative tumor growth.

Impact of Angiotensin Receptor Blockers, Beta Blockers, Calcium Channel Blockers and Thiazide Diuretics on Survival of Ovarian Cancer Patients

“…Previous retrospective cohort studies have also suggested that using beta blockers in EOC patients is associated with longer survival [14,15,23]. A pilot study demonstrated the potential role of perioperative propranolol to suppress tumor growth in EOC patients [24]. However, there are several studies with no improved survival in BB users [16,25].…”

Perioperative biobehavioral interventions to prevent cancer recurrence through combined inhibition of β‐adrenergic and cyclooxygenase 2 signaling

“…Importantly, although β-blockade and semiselective COX2 inhibition showed beneficial effects separately, their combined use was superior and, in some models, was the only effective approach; this was evident when the β-blocker propranolol was combined with the semiselective COX2 synthesisinhibitor etodolac. 12,22,33,66,67,84,89 Retrospective clinical studies have provided inconclusive results regarding incidental perioperative or chronic use of β-blockers, with several studies, [90][91][92] but not others, 93,94 reporting beneficial effects on long-term cancer outcomes, especially with respect to nonselective β-blockade. Perioperative COX inhibition also has provided inconclusive results, as recently reviewed by Cata et al 43 Notably, aspirin, a nonselective COX inhibitor, was recently recommended for the prevention of colorectal cancer (CRC) in men at risk between the ages of 50 and 59 years.…”

Variants and Perspectives of Drug Repurposing for Cancer Treatment

“…Помимо химиотерапии, предпринимаются попытки применения препарата в хирургической практике. В частности, в пилотном исследовании периоперационное введение пропранолола снижало уровень СА-125 в сыворотке крови после операции в сравнении с пациентами, не получавшими препарат [43]. Несмотря на то, что данный проект является пилотным, полученные результаты могут стать толчком в дальнейшем исследовании пропранолола в хирургической практике.…”