Findings from a novel investigation published in the Jan. 5, 2010, edition of Cancer Prevention Research are helping researchers better understand what causes basal cell carcinoma tumors.
“We always used to think that BCC was caused only by mutations in the hedgehog pathway,” Dr. Jean Y. Tang, the study’s lead author and an assistant professor of dermatology at Stanford University, said in an interview. “Now we know that the COX [cyclooxygenase] enzyme is also important for BCC development. That means we can find drugs that target COX. That should prevent or treat BCCs.”
In the phase II component of this multicenter trial, 60 patients with basal cell nevus syndrome were randomized to placebo or to 200 mg celecoxib twice daily for 24 months (Cancer Prev. Res. 2010;3:25-34). Patients with this syndrome are genetically predisposed to developing multiple basal cell carcinomas.
When the researchers stratified patients by the number of BCC tumors at baseline (fewer than 15 vs. 15 or more), celecoxib reduced the change in the number of BCCs in patients with fewer than 15 BCCs at baseline (48% vs. 22% in the placebo group) but did not have an effect in patients with 15 or more BCCs at baseline.
“That’s the surprising part,” Dr. Tang commented. “We were hoping that this drug would have more of an impact on the patients with really severe disease.”
But here’s a bigger problem: Use of celecoxib carries the potential for cardiovascular risks. So would popping another, safer COX inhibitor, such as aspirin or ibuprofen, carry the same effect? That remains to be seen.
Another limitation of the study is that it was carried out only in patients with basal cell nevus syndrome–also known as Gorlin syndrome. Dr. Tang pointed out that most patients with sporadic BCCs don’t have Gorlin syndrome. “So we don’t know if celecoxib would work against sporadic BCCs in non-Gorlin patients,” she said.