Celecoxib May Improve Breast Cancer Outcomes

Laurie Barclay, MD

December 16, 2002

Dec. 16, 2002 — The cyclooxygenase (COX)-2 inhibitor celecoxib (Celebrex) may be the next weapon in the fight against breast cancer, according to a presentation on Dec. 11 at the 25th Annual San Antonio Breast Cancer Symposium (SABCS). In a pilot study, women with locally advanced breast cancer who received celecoxib with chemotherapy were more likely to have a clinical and pathological response than women who received chemotherapy alone. On average, tumor size decreased by more than half in the combination group. The investigators suggest that more women will be able to undergo breast-conserving procedures with this regimen.

"COX-2 is overexpressed in breast cancer and it is also a novel target of treatment," write L.W.C. Chow, from the University of Hong Kong Medical Centre, and colleagues. "Celecoxib, a COX-2 inhibitor, has anti-angiogenic and apoptotic effects."

From June 2001 to November 2001, 32 patients (mean age, 45 years) with locally advanced breast cancer received either a combination of chemotherapy and celecoxib or chemotherapy alone. The treatment regimen consisted of three cycles of 5-FU, 500mg/m2; epirubicin, 75mg/m2; and cyclophosphamide, 500mg/m2 (FEC), with or without celecoxib, 400 mg twice daily, every three weeks.

Clinical response rate was 62.5% in the chemotherapy-alone arm and 81.3% in the combined arm, and the pathologic response rate was 62.5% and 87.5%, respectively. In the combined arm, the mean tumor size decreased from 4.52 ± 0.32 to 2.04 ± 0.31 cm. While 31.3% of patients chose lumpectomy, the rest opted for mastectomy. Both regimens were well tolerated without clinical cardiac toxicity.

"The combination treatment of celecoxib and FEC is effective and potentially allows more breast-conserving surgery to be performed in patients with locally advanced breast cancer," the authors write. "This is an ongoing study and will be expanded to include more patients."

25th Annual SABCS: Abstract 167. Presented Dec. 11, 2002.

Reviewed by Gary D. Vogin, MD

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