Celebrex and methotrexate for head and neck cancer – pro

Handsome doctor talking with his patient for the annual check-up

No. Celecoxib, sold under the brand name of Celebrex by Pfizer Inc., is a non-steroidal anti-inflammatory drug which has anti-angiogenic properties and has been explored in a number of cancers both therapeutically and for prevention. There is some evidence of its effectiveness for prevention in this cancer type. One particular therapeutic approach is metronomic chemotherapy iin which low doses of drugs are giving continuously over a period of time. The aim of treatment is to induce and maintain tumor dormancy (angiogenic dormancy), thus leading to long-term asymptomatic control of the disease. The expression of COX-2 enzyme is increased in head and neck cancers and it is an important mediator of angiogenesis.  The use of low doses of methotrexate have been shown in in-vivo and in-vitro to be antiangiogenic.  The combination of celecoxib and methotrexate has been reported in a small study by Gluck et al, in chemo-resistant head and neck cancers to have good efficacy without significant toxicity. A recent study by Patil et al enrolled eighteen patients with a median age of 50.5 years, 13 males and 5 females, participated in the study. Five patients had received no previous treatment while the rest had some form of previous treatment. ECOG performance status was 1 in 14 patients and 2 in 4 patients. Grade 3-4 mucositis was seen in one patient. Clinical benefit rate was 66.67%. The estimated median PFS and median OS were 5.2 months and not reached respectively.
The authors concluded that use of metronomic chemotherapy seems promising and well tolerated in this setting and that large trials are warranted to confirm these results. Much more research must follow before this promising treatment modality comes into routine clinical use.

R. N. DuBois Cyclooxygenase-2 Selective Inhibitors and Prostate Cancer: What Is the Clinical Benefit? J. Clin. Oncol., June 20, 2006; 24(18): 2691 – 2693.

Dong M. et al, Chemoprevention of Head and Neck Cancer by Simultaneous Blocking of Epidermal Growth Factor Receptor and Cyclooxygenase-2 Signaling Pathways: Preclinical and Clinical Studies Clin Cancer Res; 1–13. 2012  |  Volume : 8  |  Issue : 6  |  Page : 106-110

Patil V, Noronha V, D’cruz A K, Banavali S D, Prabhash K. Metronomic chemotherapy in advanced oral cancers. J Can Res Ther 2012;8:106-10

Glück S. Metronomic therapy in recurrent and metastatic chemoresistant SCCHN: Data from a pilot study. Proc Am Soc Clin Oncol 2003;22:A2066.

For Lay version see here

For Celebrex in other cancers see here and here