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|Common Painkillers Help Prevent Bladder Cancer Recurrence|
A number of cancers appear to overexpress the COX-2 enzyme, which may play several roles in the development of cancer.
During the 2003 annual meeting of the American Society of Clinical Oncology, Dr. Jacques LeLorier presented new findings which showed that the use of Cox-2 inhibitors (Celebrex, Vioxx) lowers the risk of recurrence for those with superficial bladder cancer. The study also looked at results from the use of the more common, over the counter non-steroidal anti-inflammatories (called NSAIDs for short)), such as aspirin, ibuprofen, Advil, Motrin and naproxen sodium (Aleve), and found that these drugs also reduced the risk of recurrence.
61.5% of non-users had a recurrence the first year, as did 56.7%
of those who used acetaminophen (Tylenol, Paracetomal). In contrast, those
treated with Cox-2 inhibitors experienced 31% recurrence, and those using
The COX enzymes produce prostaglandins, fatty acids that perform a number of hormone-like tasks. Prostaglandins alter the activities of the cells near and around where they are made. They also cause inflammation and can regulate blood flow to some organs, transport across cell membranes, and transmissions between neurons. COX-1 is responsible for the "day-to-day" production of prostaglandins, while COX-2 is highly regulated by numerous other cellular signals when needed.
Drugs which selectively target COX-2, such as Pharmacia/Pfizer's Celebrex
and Bextra and Merck's Vioxx*, have attracted much attention. They have
been remarkably successful, based on claims that they relieve pain and
inflammation while lessening the risk of stomach ulceration and bleeding
associated with traditional NSAIDs. One issue of controversy has been
whether the benefit of COX-2 inhibitors in the stomach is offset by an
increased risk of heart attack.
Phase II and III clinical trials are now in progress studying celecoxib (Celebrex). Those qualifying for the trials must have good kidney function. For Celebrex's user profile and side effect warnings, see the FDA’s page.
The NCI's Clinical Trials for bladder cancer-reducing the risk
of recurrence with celecoxib:
From the National Institutes of Health:
The National Institutes of Health (NIH) announced in December 2004 that it suspended the use of COX-2 inhibitor celecoxib (Celebrex™ Pfizer, Inc.) for all participants in a large colorectal cancer prevention clinical trial conducted by the National Cancer Institute (NCI). The study was stopped when it was discovered that participants showed a 2.5-fold increased risk of major fatal and non-fatal cardiovascular events compared to those on a placebo.
Another study showed that the COX-2 inhibitor rofecoxib (Vioxx™) caused a two-fold increased risk of cardiovascular toxicities in a trial to prevent adenomas.
"Data from the report on rofecoxib (Vioxx) informed us of the need to focus on specific cardiovascular issues, and our Institutes brought in the experts to do so", said Elias A. Zerhouni, M.D., NIH Director. "The rigor of our clinical trials system has allowed us to find this problem," said NCI Director Andrew C. von Eschenbach, M.D. NIH sponsors over 40 studies using celecoxib for the prevention and treatment of cancer [including superficial bladder cancer], dementia and other diseases. In light of these new findings, NIH Director Zerhouni requested various safety measures including a full review of all NIH-supported studies involving this class of drug.
From the National Cancer Institute:
For more information about cancer, please visit the NCI Web site at http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
For more information about regulation of COX-2 inhibitors by the FDA, please visit the FDA Web site at http://www.fda.gov/cder/drug/default.htm.
Non-steroidal anit-inflammatory drugs
For their study, Dr. Margaret R. Karagas of Dartmouth Medical School, Hanover, New Hampshire, and colleagues assessed lifetime use of analgesics and NSAIDs with the bladder cancer incidence in a population-based case-control study. Other common NSAIDs include naproxen (Aleve) and ibuprofen (Motrin).
Regular use of any NSAID was associated with a statistically significant reduced risk of bladder cancer, an association that was largely due to regular aspirin use. Regular NSAID use seemed to protect against invasive, high-grade and TP53-positive tumors, in particular.
Karagas and colleagues suggest that, "in light of the chemopreventive effects of NSAIDs including aspirin for other neoplasms, the possibility that they may reduce bladder cancer incidence warrants further consideration. Studies assessing the effect on bladder cancer prognosis are lacking but would be of great interest."
SOURCE: BMC Urology, August 10, 2007. Reuters News