Celebrex May Slow, Prevent Skin Cancers

There is mounting evidence that nonsteroidal
anti-inflammatory drugs (NSAIDs) may help prevent or slow the growth of
non-melanoma skin cancers.

In a study published today, the Cox-2 arthritis drug Celebrex was found to
reduce the growth of basal cell skin cancers by 50% in some patients with a
rare genetic condition that makes them highly susceptible to the tumors.

And in a separate study reported last May, people who took Celebrex daily
for nine months had 60% fewer non-melanoma skin cancers than people who did not
take the drug.

Celebrex and other Cox-2 inhibitors act on the cyclooxygenase-2 enzyme
involved in inflammation.

Stanford University assistant professor of dermatology Jean Y. Tang, MD,
PhD, says the findings suggest a role for the cyclooxygenase enzyme in the
development of basal cell carcinoma and possibly other non-melanoma skin
cancers.

"Basal cell carcinomas are the most common cancer in the United States," she
says. "Even though these tumors are not lethal they can have a big impact on
quality of life, and we have no way to treat them short of surgical
removal."

Study Ended Early Amid Vioxx Concerns

Even if Celebrex does slow skin cancer growth, it is probably not an
appropriate preventive treatment for most people, Tang says.

"We certainly aren't recommending that people take this drug to reduce their
risk for basal cell carcinomas," she says.

That is because of concerns about an increase in heart attack and stroke
risk associated with the use of Cox-2 drugs. The Cox-2 drug Vioxx was withdrawn
from the market by its manufacturer, Merck, in 2004 after studies linked its
long-term use to an increase in deaths due to heart attack, stroke, and
other cardiovascular events.

The study conducted by Tang, along with Ervin H. Epstein, Jr. of the
Children's Hospital Oakland, was begun in 2001, before the cardiovascular risks
were publicly reported.

The study included 60 patients with a very rare genetic condition known as
Gorlin syndrome. Gorlin's patients can develop hundreds and even thousands of
basal cell carcinomas over the course of their lives.

The study participants were treated with a standard therapeutic dose of
Celebrex (200 milligrams, twice a day) or a placebo. Neither the patients nor
the investigators knew which treatment was being given.

The treatment arm of the trial was stopped in 2004 in response to concerns
raised by the Vioxx studies. Nevertheless, most patients received two years of
active treatment and were followed for an additional year.

While both treatment groups continued to develop new cancers during the
study, treatment with Celebrex was associated with a 50% decrease in the growth
of skin tumors among patients who entered the trial with 15 or fewer skin
tumors.

Treatment with the NSAID was also found to reduce the total number of tumors
in these patients, but not in patients with more than 15 basal cell
carcinoma-related skin lesions at study entry.

The findings appear in the January issue of the journal Cancer Prevention
Research.

New Strategy: The Hedgehog Pathway

Tang says it remains to be seen if other oral or even topical NSAIDs can
prevent or slow the growth of basal cell carcinomas and other non-melanoma skin
cancers.

In an editorial published with the study, Johns Hopkins University
oncologist Charles M. Rudin, MD, PhD, writes about another promising skin
cancer prevention strategy, which targets something known as the hedgehog
pathway.

"The hedgehog pathway is essentially a cell program that is turned on in
fetal development but is normally shut off in adult tissue," Rudin tells WebMD.
"But in some cancers this pathway is turned on, and basal cell carcinoma is one
of those cancers."

In early studies, Rudin and colleagues showed significant reductions in skin
lesions when patients with basal cel carcinomas took drugs designed to
inhibit, or shut off, the hedgehog pathway.

A trial is now under way in patients with Gorlin syndrome to determine if
hedgehog-inhibiting drugs prevent or slow the growth of tumors in this
high-risk group.

By Salynn Boyles
Reviewed by Louise Chang
©2005-2008 WebMD, LLC. All rights reserved