Nonsteroidal anti-inflammatory drugs and cancer
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a diverse group of medications commonly used for pain relief, inflammation reduction, and fever management. Familiar examples include ibuprofen and naproxen. In the context of cancer, NSAIDs are utilized to alleviate pain associated with various cancers and may have potential benefits in reducing the risk of specific types, particularly colorectal cancer. They work by inhibiting cyclooxygenase enzymes, which decreases the production of prostaglandins, the hormones responsible for inflammation and pain.
While some studies suggest that NSAIDs could play a role in cancer prevention, especially for gastrointestinal malignancies, the evidence is mixed and conclusive findings are still lacking. Common side effects of NSAIDs include gastrointestinal issues, dizziness, and headaches, with severe allergic reactions possible. Notably, certain COX-2 inhibitors have been withdrawn from the market due to serious cardiovascular risks, leaving Celecoxib as the only major COX-2 inhibitor available, albeit with significant warnings. As with any medication, it is important for individuals to consult healthcare professionals regarding the benefits and risks associated with NSAID use in the context of cancer management.
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Nonsteroidal anti-inflammatory drugs and cancer
ATC CODE: M01A
DEFINITION: Nonsteroidal anti-inflammatory drugs (NSAIDs) are a large, heterogeneous group of pain management medications also used to treat fever and inflammation. Examples include ibuprofen, like Advil and Motrin, and naproxen, such as Aleve.
Cancers treated: NSAIDs are used to treat all types of pain and discomfort associated with cancer, arthritis, gout, and dysmenorrhea (painful or difficult menstruation). They may have an inhibitory effect on bone tumors, reduce the risk of colorectal cancer, and may promote centrally mediated analgesia.
Subclasses of this group: NSAIDs are weak organic acids. Subclasses include salicylates, propionic acids, pyrrole alkanoic acid derivatives, phenylalkanones, indolic acids, pyrazolone derivatives, and phenyl-naphthyl-acetic acids.
Delivery routes: These drugs are generally administered orally in a liquid, capsule, or tablet suspension. Certain drugs can be given intravenously, such as an intramuscular injection, or as a rectal suppository, topical ointment, or an ophthalmic solution.
How these drugs work: NSAIDs inhibit cyclooxygenase enzyme activity, resulting in decreased synthesis of prostaglandins (hormones that produce inflammation and pain). Cyclooxygenase 2 (COX-2) inhibitors perform the same function but mediate the metabolic pathway by selectively blocking the COX-2 enzyme. Though some studies indicate NSAIDs may help prevent some types of cancers, particularly colorectal and gastrointestinal cancers, research findings are conflicting, and conclusive data is lacking.
Side effects: Common complaints from NSAID use include headache, dizziness, gastrointestinal symptoms (nausea, stomach cramps, gastric ulceration, and diarrhea), tremor, insomnia, skin rash, and platelet dysfunction. An anaphylactic (allergic) response to a particular NSAID can present as hives, rash, intense itching, and respiratory difficulties. This condition can be life-threatening, and immediate emergency treatment is required.
The COX-2 inhibitors Vioxx and Bextra were pulled from the U.S. market by the Food and Drug Administration (FDA) in the early 2000s. Over an extended period of use (more than eighteen months), they significantly increased patients' risk for heart attack and stroke. Only Celecoxib (Celebrex) remains on the market, with significant warnings attached to its use and potential risks.
Bibliography
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International Agency for Research on Cancer. IARC Handbooks of Cancer Prevention: Non-Steroidal Anti-Inflammatory Drugs. World Health Organization, 1997.
Kolawole, Oluwafunke R., and Khosrow Kashfi. “NSAIDs and Cancer Resolution: New Paradigms beyond Cyclooxygenase.” International Journal of Molecular Sciences, vol. 23, no. 3, 27 Jan. 2022, doi:10.3390/ijms23031432.
"Non-opioids and Other Drugs Used to Treat Cancer Pain." American Cancer Society, 29 Mar. 2024, www.cancer.org/cancer/managing-cancer/side-effects/pain/cancer-pain/non-opioids-and-other-drugs-to-treat-cancer-pain.html. Accessed 20 June 2024.
"Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)." MedicineNet, www.medicinenet.com/nonsteroidal‗anti-inflammatory‗drugs‗nsaid/article.htm. Accessed 20 June 2024.
Wong, Rebecca S. Y. “Role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Cancer Prevention and Cancer Promotion.” Advances in Pharmacological Sciences, 31 Jan. 2019, doi:10.1155/2019/3418975.