{"entity":{"id":"idea-bio2-perioperative-betablocker-nsaid","kind":"idea","name":"Cheap perioperative beta-blocker plus anti-inflammatory to blunt surgical stress","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Metastasis is understood least and studied last): Dillekås et al., Are 90% of deaths from cancer caused by metastases? (Cancer Medicine 2019)","url":"https://doi.org/10.1002/cam4.2474"}],"tags":[],"related":[],"cancers":["colorectal","breast-hr-positive"],"sections":[],"technologies":["mrd-testing"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":["emt"],"terms":[],"trials":[],"people":[],"bottlenecks":["b-metastasis-biology","b-generic-repurposing"],"keyPapers":["paper-dillekas-cancer-med"],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"medium","horizonYears":6},"route":"/ideas/idea-bio2-perioperative-betablocker-nsaid/","neighbours":{"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"technology":[{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"pathway":[{"id":"emt","kind":"pathway","name":"Epithelial-mesenchymal transition & drug efflux","route":"/pathways/emt/"}],"bottleneck":[{"id":"b-metastasis-biology","kind":"bottleneck","name":"Metastasis is understood least and studied last","route":"/bottlenecks/b-metastasis-biology/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"}],"paper":[{"id":"paper-dillekas-cancer-med","kind":"paper","name":"Are 90% of deaths from cancer caused by metastases?","route":"/key-papers/paper-dillekas-cancer-med/"}]}}