FDA Approves Celebrex for Rare Genetic Disorder
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"What is especially interesting about FAP, or persons who have the germ line mutation, is that the development of tumors in FAP is similar to that in the general population with sporadic human colon cancer," Steinbach tells WebMD. "The only difference is that, in sporadic cancer, the mutation is not inherited; it happens randomly. ... By the time tumors develop, the patient has the mutations ... and the tumors progress in a similar fashion, but with many fewer tumors. That's why there is a lot of work with FAP, because it is very likely that drugs effective in FAP could be used in prevention of sporadic colon cancer."
Steinbach says that investigators are focusing on the Cox-2 pathway because, unlike Cox-1, which is present in most human cells, Cox-2 is found only in the presence of inflammation. It is this inflammatory link that makes the drugs effective against arthritis and may also offer a clue to the role of non-steroidal anti-inflammatory drugs (NSAIDs) in prevention of colon cancer, he says.
Steinbach wouldn't speculate further, though, on using Cox-2 inhibitors not just to treat patients with the genetic mutation for FAP, but to prevent the onset of the disease before symptoms present themselves. "This [study] is a first step. It would require further study to assess a Cox-2 inhibitor for prevention," he says.
John Bond, MD, a gastroenterologist and professor of medicine at the University of Minnesota in Minneapolis, told WebMD in an earlier interview, "Most people are predicting that [Cox-2 drugs] probably will play a role in the future to prevent colon cancer altogether. It could be a reason to take the drugs regularly, or it could be a bonus if you take them for something else."
Research gives indications that the Cox-2 inhibitors may even help prevent a range of cancers beyond the colorectal varieties. Andrew Dannenberg, MD, professor of medicine at Weill Medical College at Cornell University in Ithaca, N.Y., told WebMD, "In the laboratory, we've demonstrated that Cox-2 is overexpressed in a variety of human malignancies, ranging from lung cancer to pancreatic cancer to head and neck cancer to breast cancer."