Neurokinin-1 receptor (NK-1R) antagonists exert antitumor action, are safe and do not cause serious side-effects. These antagonists (via the NK-1R) exert multiple actions against cancer: antiproliferative and anti-Warburg effects and apoptotic, anti-angiogenic and antimetastatic effects. These multiple effects have been shown for a broad spectrum of cancers. The drug aprepitant (an NK-1R antagonist) is currently used in clinical practice as an antiemetic. In in vivo and in vitro studies, aprepitant also showed the aforementioned multiple antitumor actions against many types of cancer. A successful combination therapy (aprepitant and radiotherapy) has recently been reported in a patient suffering from lung carcinoma: the tumor mass disappeared and side-effects were not observed. Aprepitant could be considered as an intelligent bullet against cancer. The administration of aprepitant in cancer patients to prevent recurrence and metastasis after surgical procedures, thrombosis and thromboembolism is discussed, as is the possible link, through the substance P (SP)/NK-1R system, between cancer and depression. Our main aim is to review the multiple antitumor actions exerted by aprepitant, and the use of this drug is suggested in cancer patients. Altogether, the data support the reprofiling of aprepitant for a new therapeutic use as an antitumor agent.

The past two decades have witnessed an exponential increase in research into cancer. This effort, however, has not been translated into better perspectives as regards the problem, although several fields of research have certainly been promising (the human genome project, gene therapy, the search for new cytostatic agents and stem cell research). New pathways must be opened up to offer future hope to oncologic patients. Thus, there is a need to explore other research initiatives in cancer ways to improve this chronic global problem. Substance P (SP) has a widespread distribution in both the central and peripheral nervous systems. It is known that after binding to the specific neurokinin-1 (NK-1) receptor, SP regulates biological functions related to cancer, such as tumour cell proliferation, angiogenesis, and migration of the tumour cells for invasion and metastasis. By contrast, it is also known that after binding to NK-1 receptors, the NK-1 receptor antagonists specifically inhibit tumour cell proliferation (tumour cells die by apoptosis), angiogenesis and the migration of the tumour cells. It is also known that NK-1 receptors are overexpressed in tumours. All these observations suggest that the SP/NK-1 receptor system could play an important role in the development of cancer and metastasis; that the NK-1 receptor could be a new promising target in the treatment of cancer, and that NK-1 receptor antagonists could improve cancer treatment.

We propose several pathways that could be involved in major depression. According to our proposal, noradrenaline hypoactivity could occur through a strong presynaptic GABAergic inhibition, via GABA_B receptors, and serotonin hypoactivity through a strong glutaminergic inhibition via subreceptor 5 of the metabotropic glutaminergic receptor. In this sense, it is important to know whether the antagonists of such receptors might be able to improve the symptoms observed in major depression. Some neuropeptides are also altered in such states (corticotropin-releasing hormone, neuropeptide Y, galanin). It is also important to know whether in addition to current antidepressants the administration of neuropeptides and their agonists/antagonists could ameliorate depressive symptoms.

After binding to the specific neurokinin-1 (NK-1) receptor, the peptide substance P (SP), which is widely distributed in both the central and peripheral nervous systems, induces tumor cell proliferation, angiogenesis, and migration of the tumor cells for invasion and metastasis. However, after binding to NK-1 receptors, NK-1 receptor antagonists inhibit the three above mechanisms. In fact, the antiproliferative action exerted by NK-1 receptor antagonists is because they induce cancer cells to die by apoptosis, whereas SP exerts an antiapoptotic effect. Moreover, it is known that NK-1 receptors are overexpressed in tumors and that tumor cells express several isoforms of the NK-1 receptor. All these data suggest that the SP/NK-1 receptor system could play an important role in the development of cancer; that SP may be a universal mitogen in NK-1 receptor-expressing tumor cells, and that NK-1 receptor antagonists could offer a promising therapeutic strategy for the treatment of human cancer, since they act as broad-spectrum antitumor agents. In sum, the NK-1 receptor may be a new and promising target in the treatment of human cancer.