Surgical stress and cancer progression: the twisted tango

Table 1 Therapeutic regimens to prevent cancer recurrence after surgery

Drug	Description	Perioperative anti-tumor mechanism	Examples	Reference
β-adrenoceptor antagonists (β-blockers)	Inhibitor of β-adrenoceptors; used to treat heart failure, tachycardia, and hypertension	Blockade of stress-induced catecholamine release	Propranolol, Metoprolol	[132,133,134,135,136,137]
NSAIDs	Inhibitor of cyclo-oxygenase; use to reduce pain, fever, inflammation, and prevent blood clots	Inhibition of COX-2	Aspirin, Meloxicam, Celecoxib, Parecoxib	[10, 138,139,140,141]
PDE-5 inhibitors	Inhibitor of PDE-5, conventionally used to treat erectile dysfunction	Downregulation of ARG1, IL4Ra and ROS expression	Sildenafil, Tadalafil	[96]
Immunostimulants	Many diseases such as malignancy will stimulate the immune system	Activation of immune cells (e.g. NK cells)	Toll-like receptor agonists, vaccines, checkpoint inhibitors	[142,143,144,145,146,147,148]
Statins	Lipid-lowering medications	Inhibition of HMG-CoA reductase or cholesterol synthesis	Fluvastatin	[149]
Anticoagulants	Inhibit thrombosis	Inhibit formation of fibrin and platelet clots	Aspirin, heparin, warfarin	[72, 150,151,152]
Bevacizumab	Inhibits angiogenesis	Inhibits VEGF	Bevacizumab	[153]

Abbrevations : NSAIDs, nonsteroidal anti-inflammatory drugs; COX-2, Cyclooxygenase 2; NK, natural killer; HMG-CoA, β-Hydroxy β-methylglutaryl-CoA; VEGF, Vascular endothelial growth factor; PDE-5, Phosphodiesterase-5; ARG1, Arginase 1; ROS, reactive oxygen species

ISSN: 1476-4598