Celecoxib: Effective in Former Smokers as Lung Cancer Chemoprevention

A recent study revealed that celecoxib (Celebrex), a COX-2 inhibitor, might be a successful lung cancer chemoprevention in former smokers. Despite advances in lung cancer therapy the World Health Organization still cites lung cancer as the major cause of cancer-related death worldwide, showing the need for early detection and prevention.

The findings from this phase IIb randomized, double-blind, placebo-controlled trial looking at celecoxib in former smokers are similar to a previous trial examining celecoxib in both current and former smokers (Cancer Prev Res. 2010;3(2):148-159).

“The oncology community does not have a good treatment for lung cancer. Unless it is caught in the earliest stages, the five-year survival is only about 15 percent,” said J. Jack Lee, PhD, a professor of biostatistics at The University of Texas MD Anderson Cancer Center in Houston. “The best way is to intercept at the earliest stages and try to reverse the processes that can lead to cancer. These studies suggest celecoxib may be a tool to do that.”

A concern over the relationship between celecoxib and cardiovascular (CV) events during the enrollment of the trial resulted in fewer participants than initially desired. The trial enrolled 137 participants that were randomized into 2 arms, 68 patients received 400 mg celecoxib and 69 patients received placebo. Only those with baseline risk factors experienced adverse CV events over the course of the trial.

Celecoxib demonstrated its potential use as a chemopreventive agent by meeting its primary endpoint of benefit in bronchial health, as measured using a labeling index of Ki-67, a proliferation marker that presents throughout the cell cycle. The secondary endpoints of the trial focused on molecular markers, histology, and computed tomography (CT).

The study revealed an association between celecoxib and decreased 12-month CT-detection/resolution of lung nodules. Focusing on markers as a secondary endpoint helped determine the role of the COX-2/PGE2 pathway in lung carcinogenesis. Identification and use of this pathway will be further examined in Phase III trials.

“Taken together, these findings strongly suggest that celecoxib can be used as a chemopreventive agent in these high-risk groups,” said Jenny T. Mao, MD, a professor of medicine at the University of New Mexico and section chief of pulmonary and critical care medicine at the New Mexico VA Health System in Albuquerque.

Mao JT, Roth MD, Fishbein MC, et al. Lung cancer chemoprevention with celecoxib in former smokers. Cancer Prev Res. 2011;4(7):984-993.