Pharmacologic interventions with NSAIDs

Abstract

Obesity as a determinant of increased cancer risk and poorer cancer outcome is well established for cancers of several organ sites, including colorectal and postmenopausal breast cancer. Obesity-associated adipose inflammation leads to local and systemic accumulation of inflammatory mediators and hormones, which have multiple proneoplastic effects. Key among these from a pharmacological perspective are cyclooxygenase (COX)-derived prostaglandins (PGs), since COX enzymes are the primary target for nonsteroidal anti-inflammatory drugs (NSAIDs). Overexpression of the inducible PG synthase COX-2 occurs in the majority of colorectal neoplasias and ~40 % of breast cancers and is also evident in inflamed adipose tissue from obese mice and humans. COX/PG signaling has multiple protumorigenic consequences, which provide at least a partial explanation for epidemiologic and experimental observations of reduced cancer risk associated with NSAID use. Notably, COX/PG-mediated upregulation of estrogen biosynthesis and signaling offers a plausible target for NSAID-mediated risk reduction with respect to breast and other hormone-sensitive cancers. Additionally, "off-target" NSAID effects including modulation of NFκB and AMP kinase activity may be of particular significance in the context of obesity. NSAID-mediated amelioration of obesity- related metabolic dysfunction has been reported, and it seems likely that NSAIDs will be similarly protective for obesity-associated carcinogenesis.