- Panigrahy, Dipak;
- Gartung, Allison;
- Yang, Jun;
- Yang, Haixia;
- Gilligan, Molly M;
- Sulciner, Megan L;
- Bhasin, Swati S;
- Bielenberg, Diane R;
- Chang, Jaimie;
- Schmidt, Birgitta A;
- Piwowarski, Julia;
- Fishbein, Anna;
- Soler-Ferran, Dulce;
- Sparks, Matthew A;
- Staffa, Steven J;
- Sukhatme, Vidula;
- Hammock, Bruce D;
- Kieran, Mark W;
- Huang, Sui;
- Bhasin, Manoj;
- Serhan, Charles N;
- Sukhatme, Vikas P
Cancer therapy is a double-edged sword, as surgery and chemotherapy can induce an inflammatory/immunosuppressive injury response that promotes dormancy escape and tumor recurrence. We hypothesized that these events could be altered by early blockade of the inflammatory cascade and/or by accelerating the resolution of inflammation. Preoperative, but not postoperative, administration of the nonsteroidal antiinflammatory drug ketorolac and/or resolvins, a family of specialized proresolving autacoid mediators, eliminated micrometastases in multiple tumor-resection models, resulting in long-term survival. Ketorolac unleashed anticancer T cell immunity that was augmented by immune checkpoint blockade, negated by adjuvant chemotherapy, and dependent on inhibition of the COX-1/thromboxane A2 (TXA2) pathway. Preoperative stimulation of inflammation resolution via resolvins (RvD2, RvD3, and RvD4) inhibited metastases and induced T cell responses. Ketorolac and resolvins exhibited synergistic antitumor activity and prevented surgery- or chemotherapy-induced dormancy escape. Thus, simultaneously blocking the ensuing proinflammatory response and activating endogenous resolution programs before surgery may eliminate micrometastases and reduce tumor recurrence.