NSAID eased basal cell carcinoma burden in patients with genetic predisposition

The use of the non-steroidal antiinflammatory COX2 inhibitor celecoxib significantly decreased basal cell carcinoma tumor burden in people with a rare skin disorder that predisposes them to the disease.

People with Gorlin syndrome are predisposed to basal cell carcinoma and can develop hundreds of basal cell tumors throughout their lives. These patients have a mutated PTCH1 gene, which encodes a primary hedgehog pathway inhibitor.

Researchers first tested the genetic deletion of PTCH1 and the inhibition of COX enzymes in PTCH1 mice. In this trial, genetically knocking out COX2 enzyme expression decreased tumor burden by 75% (P<.05). Inhibiting COX enzymes using celecoxib (Celebrex, Pfizer) decreased basal cell carcinoma tumor burden by 35% (P<.05).

Next, they conducted a placebo-controlled, randomized, double blind, phase-2 study of the use of celecoxib in patients with Gorlin syndrome. According to the researchers, the goal of the study was to reduce the number of basal cell carcinomas in this patient population.

Sixty patients with basal cell carcinoma were randomly assigned either 200 mg of oral celecoxib two times a day or placebo.

At two-year’s follow-up, patients on placebo had a 37% increase in basal cell carcinoma per year vs. 26% in patients assigned celecoxib; however, this difference was not statistically significant.

The researchers then stratified patients according to the number of basal cell carcinoma tumors they had at baseline. In patients with fewer than 15 basal cell carcinoma, celecoxib reduced the change in number of basal cell carcinoma compared with patients with more than 15 basal cell carcinoma (48% vs. 22%; P=.04). Celecoxib also reduced tumor burden in patients with fewer than 15 basal cell carcinoma (50% vs. 20%; P=.02)

There was no difference in the rate or severity of adverse effects between patients in either group. Although the results of this study showed positive results in reducing cancer, researchers suggested that concerns remain about the potential cardiovascular adverse effects that may be associated with this drug.

Tang JY. Cancer Prev Res. 2010;3:25-34.