Surgical resection is a cornerstone of standard-of-care treatment for early-stage non-small
      cell lung carcinoma (NSCLC) and renal cell carcinoma (RCC). Yet despite optimal treatment,
      many of these patients will develop cancer recurrence within the first few years. For
      example, the 5-year survival rate for patients with stage I/II NSCLC is only around 55%. As a
      result, more effective treatments that decrease cancer recurrence and increase survival are
      still needed.

      Surgery induces inflammation, immunosuppression and angiogenesis. Although these processes
      are important for wound healing in response to tissue injury caused by surgery, they also
      support the survival, growth and dissemination of any remaining cancer cells and can lead to
      systemic recurrence soon after surgery. Surgical trauma increases the production of
      prostaglandins and thromboxanes, which have tumor-promoting and immunosuppressive activities,
      and reduces the activity of natural killer cells, which impairs the ability of the immune
      system to keep cancer cells in check. However, if given just before tissue injury,
      non-steroidal anti-inflammatory drugs (NSAIDs) may be able to block the production of
      prostaglandins/thromboxanes and boost the activity of natural killer cells, and thereby
      decrease the risk of cancer recurrence. NSAIDs such as ketorolac are already routinely given
      to cancer patients postoperatively for pain management and are sometimes given
      intraoperatively (immediately before or during surgery) to prevent postoperative pain. A
      retrospective clinical analysis found that intraoperative intravenous ketorolac or diclofenac
      (another NSAID), when added to standard of care for patients with stage I/II NSCLC, was
      associated with decreased risks of distant recurrence and mortality.

      There is significant promise in the use of preoperative ketorolac to decrease the
      inflammatory response after surgical resection of tumors, thereby potentially reducing the
      risk of distant metastatic tumor spread and improving survival.

      Patients will be screened and recruited during the preoperative period by the responsible
      medical and surgical team. Blood will be drawn preoperatively and then at the end of the
      surgical procedure. Participants will be randomized to either preoperative ketorolac group or
      a concurrent control group who will not receive preincisional ketorolac. The concurrent
      control group is to obtain untreated biologic samples for biologic correlative studies and
      secondary endpoints. These patients will not be compared to the investigational cohort in
      regards to the primary endpoint of safety. Patients will be randomized on the day of surgery
      to either the experimental or control arms and participants will be followed or 28 days.
      Medical records will be reviewed at 1 and 2 years post-surgery for survival assessment.