Repurposing tranexamic acid as an anticancer drug: a systematic review and meta-analysis

Abstract

Abstract Purpose Drug repurposing may be an efficient strategy for identifying new cancer treatments. Tranexamic acid (TXA), an antifibrinolytic agent that affects the plasminogen-plasmin pathway, may have potential anticancer effects by influencing tumor cell proliferation, angiogenesis, inflammation, immune response, and tissue remodeling—all crucial processes contributing to tumor progression and metastasis. Objective Evaluate TXA’s anticancer effects across in vitro, animal, and clinical studies to assess its potential as a repurposed cancer drug. Methods The study was designed as a PRISMA-compliant systematic review and meta-analysis. The literature search was conducted in MEDLINE, EMBASE, Web of Science, and the Cochrane Library. In vitro, animal, and clinical studies investigating the anticancer effects of TXA or epsilon-aminocaproic acid (EACA) were included. Animal and clinical studies were critically appraised, and studies with a low risk of bias were included in the meta-analysis. Results Of 4367 identified records, 38 articles were included, collectively reporting findings from 41 in vitro studies, 34 animal studies (n = 843 animals), and seven clinical studies (n = 91 patients). The meta-analysis included nine animal studies and showed a tumor growth reduction in animals treated with TXA compared to controls with a standardized mean difference of – 1.0 (95%CI – 1.5; – 0.4) (p = 0.0002). Equivalently, the majority of in vitro studies reported reduced proliferation, viability, and invasiveness in TXA-exposed tumor cell lines. The clinical studies were considerably susceptible to bias, rendering any conclusions futile. Conclusions TXA shows promise as a repurposed cancer drug, revealing an overall reduction in tumor growth, viability, and invasiveness in animal and in vitro studies.

Keywords

• Tranexamic acid
• Drug repurposing
• Cancer therapy
• Anticancer agents
• Systematic review
• Antifibrinolytics