A nervous tumor microenvironment: the impact of adrenergic stress on cancer cells, immunosuppression, and immunotherapeutic response

Jason W.L. Eng, Kathleen M. Kokolus, Chelsey B. Reed, Bonnie L. Hylander, Wen W. Ma, Elizabeth A. Repasky

Research output: Contribution to journalReview article

70 Scopus citations


Long conserved mechanisms maintain homeostasis in living creatures in response to a variety of stresses. However, continuous exposure to stress can result in unabated production of stress hormones, especially catecholamines, which can have detrimental health effects. While the long-term effects of chronic stress have well-known physiological consequences, recent discoveries have revealed that stress may affect therapeutic efficacy in cancer. Growing epidemiological evidence reveals strong correlations between progression-free and long-term survival and β-blocker usage in cancer patients. In this review, we summarize the current understanding of how the catecholamines, epinephrine and norepinephrine, affect cancer cell survival and tumor progression. We also highlight new data exploring the potential contributions of stress to immunosuppression in the tumor microenvironment and the implications of these findings for the efficacy of immunotherapies.

Original languageEnglish (US)
Pages (from-to)1115-1128
Number of pages14
JournalCancer Immunology, Immunotherapy
Issue number11
StatePublished - Oct 25 2014



  • Catecholamines
  • Immunosuppression
  • Immunotherapies
  • Nervous system
  • Stress

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Oncology
  • Cancer Research

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