Beyond Psychotropic: Potential Repurposing of Fluoxetine toward Cancer Therapy

Abstract

Drug repurposing, rebranding an existing drug for a new therapeutic indication, is deemed a beneficial approach for a quick and cost-effective drug discovery process by skipping preclinical, Phase 1 trials and pharmacokinetic studies. Several psychotropic drugs, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), were studied for their potential application in different diseases, especially in cancer therapy. Fluoxetine (FLX) is one of the most prescribed psychotropic agents from the SSRIs class for the treatment of several neuropsychiatric disorders with a favorable safety profile. FLX exhibited different oncolytic effects via mechanisms distinct from its main serotonergic activity. Taking advantage of its ability to rapidly penetrate the blood-brain barrier, FLX could be particularly useful in brain tumors. This was proved by different in vitro and in vivo experiments using FLX as a monotherapy or combination with temozolomide (TMZ) or radiotherapy. In this review of the literature, we summarize the potential pleiotropic oncolytic roles of FLX against different cancers, highlighting the multifaceted activities of FLX and its ability to interrupt cancer proliferation via several molecular mechanisms and even surmount multidrug resistance (MDR). We elaborated on the successful synergistic combinations such as FXR/temozolomide and FXR/raloxifene for the treatment of glioblastoma and breast cancer, respectively. We showcased beneficial pharmaceutical trials to load FLX onto carriers to enhance its safety and efficacy on cancer cells. This is the first review article extensively summarizing all previous FLX repurposing studies for the management of cancer.

Keywords: cancer; fluoxetine; multidrug resistance (MDR); repurposing.

Figure 1

The number of scientific publications comprising scientific output linking repurposing studies with cancer over the period 2005–2023. Data were retrieved from the Web of Science database by using the keywords “repurposing” and “cancer”.

Figure 2

Chemical structure of fluoxetine (FLX) and summary of different sensitive cancers to fluoxetine treatment.

Figure 3

Similarity of fluoxetine (FLX) to a VEGFR2 inhibitor, CHEMBL437889; and a multitarget kinase inhibitor, CHEMBL3642580.