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Opioids and cancer survival: are we looking in the wrong place?

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journal contribution
posted on 2022-07-07, 10:54 authored by Despina Giakomidi, Mark F. Bird, David G. Lambert

There is a controversial narrative in the anaesthetic literature suggesting that anaesthetic technique (including opioids) may be detrimental to survival after tumour resection. The initial observations were retrospective. Several prospective studies are ongoing; one in breast cancer has reported no adverse outcome. The evidence for an effect of opioids stems from three pieces of information: (1) opioids depress the immune system, (2) opioids potentially promote angiogenesis, and (3) opioids potentially support tumour growth. Although the evidence for (2)/(3) is unclear, combinations of these effects are beneficial to tumours and potentially promote metastatic reseeding. Accepted wisdom suggests that opioid effects are driven by opioid receptor activation but the presence of opioid receptors on immune cells for example is unlikely. Immune cells, vascular endothelium and a range of tumour cells express Toll-like receptor 4 (TLR4) receptors (for Gram-negative bacterial wall components), and there is growing evidence for opioids interacting with this alternative receptor; and for some there is paradoxical naloxone sensitivity. Is the focus on opioid receptors and cancer the wrong target? TLR4 receptor activation produces immune activation, stimulates angiogenesis, and supports tumour survival. We know that some opioids are more immune suppressive than others (there is no such comparative information for angiogenesis and tumour survival); this may correlate with TLR4 activation. If there are clusters of opioids that have more opioid than TLR4 profiles and vice versa, this may influence outcome. If this is the case, then evidence-based advice could be given for perioperative use in the oncology–anaesthesia setting.

Funding

Work on opioids in the authors' laboratory is funded by Project grants from British Journal of Anaesthesia/Royal College of Anaesthetists and British Heart Foundation.

History

Citation

BJA Open, 2 (C): 100010 (2022)

Author affiliation

Department of Cardiovascular Sciences

Version

  • VoR (Version of Record)

Published in

BJA Open

Volume

2

Publisher

Elsevier

issn

2772-6096

Acceptance date

2022-03-30

Copyright date

2022

Available date

2022-07-07

Language

en

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