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COX-2 Inhibitor May Boost Capecitabine Response

COX-2 Inhibitor May Boost Capecitabine Response

HOUSTON—The COX-2 inhibitor celecoxib (Celebrex) appears to improve
tumor response to capecitabine (Xeloda) and may help relieve hand-foot
syndrome, according to results of a retrospective study by researchers at
M.D. Anderson Cancer Center. Lead investigator Edward H. Lin, MD, assistant
professor of medicine, Division of Gastrointestinal Medical Oncology, said
that the group is planning a prospective trial of the combination.

Case-Control Study

The case-control study, reported in abstract form at the 38th Annual
Meeting of the American Society of Clinical Oncology (abstract 2364),
compared the results of 67 patients with metastatic colorectal cancer who
were taking either capecitabine alone (1,000 to 1,250 mg/m² bid on days 1 to
14 of a 21-day cycle) or capecitabine plus celecoxib (200 mg bid for pain,
started on day 1 and taken daily); the majority of patients in both groups
were on the 1,000 mg/m² bid capecitabine dose.

Dr. Lin noted that patient demographics tended to favor the
capecitabine-alone group. Their median age was lower than that of the
combination group (55 vs 65, respectively), and more of the patients were
chemotherapy naïve (31% vs 11%). The majority of patients in both groups
had received one or two prior chemotherapy regimens. About half the patients
in both groups had failed irinotecan (Camptosar) and/or oxaliplatin (Eloxatin,
investigational in the United States).

Performance status, too, favored the capecitabine-alone group: No
patients in the capecitabine-alone group were ECOG performance status 2,
whereas 24% of the patients on the capecitabine/celecoxib combination were
performance status 2.

Disease Stabilization

Despite the apparent demographic disadvantage, treatment results were
better in the capecitabine/celecoxib group. "There seems to be improved
disease stabilization among patients taking capecitabine and celecoxib as
compared to capecitabine alone," Dr. Lin said. "And the stable
disease has lasted longer than 3 months."

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