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Ironically, the trial that exposed the heart risks of COX-2 inhibitors was a cancer experiment, designed to test whether Vioxx or Celebrex could prevent the recurrence of colon cancer. It was halted before any conclusion could be reached. The situation was even more frustrating for patients in a second trial. There, scientists did indeed find a lower recurrence of colon tumors in patients taking Vioxx. "There was a reduction in adenoma recurrence," notes the study's lead author, Dr. Robert Bresalier of MD Anderson Cancer Center. "How that balances with the potential risk remains to be seen...
...indeed. The news from last week's ASCO meeting reassured me that I made the right decision when I rejoined the Celebrex study. Joining the trial in the first place seemed utterly logical--I had cancer of the esophagus, and I was going to go after every advantage I could. My surgeon, Dr. Nasser Altorki, chief of thoracic surgery at Weill Cornell Medical Center in New York City, is both a top esophageal specialist and a researcher. He has been investigating--along with my oncologist, Dr. Roger Keresztes, also at Weill--whether COX-2 inhibitors have a role in making...
Scientists initially became interested in the COX-2 enzyme because it's found in so many cancer cells. When active, COX-2 produces a chemical called a prostaglandin that helps keep the stomach lining healthy. It also helps the kidney and blood platelets function properly. In tumors, however, prostaglandin becomes a bad actor, an evil conspirator that helps build the new blood supplies that tumors need to grow. COX-2 also makes cancer cells more resistant to the body's immune response and more resistant to drugs. What would happen, scientists wondered, if you suppressed the COX-2 enzyme with...
Here's what led me back to the trial: first, I didn't want to lose the potential benefit. Second, I'm middle aged and in pretty good shape, and thus younger and fitter than most people with my flavor of cancer. I figured the slightly elevated heart risk was, for me, a more manageable proposition. That's pure rationalization, of course. The bonus round: for an aging gym rat, Celebrex is a wonder at relieving the aches and pains that come from too much exercise...
There's another, more important part of the equation. The worst side effect of cancer that I can think of is being dead. The cure rate for all lung cancer patients is 14%; it's even lower for esophageal cancer. Hell, the treatment alone can kill you, given the toxicity of cancer drugs. "You tell me, what risk are these people willing to take?" asks Altorki. Only so much, it seems; about half of the surviving subjects in my study opted...