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Good News: Celebrex Found to Cut Risk of Colon Cancer;Bad News: It still increases cardiovascular risk

Celecoxib (Celebrex, Pfizer, Inc.) was one of the last selective cyclo-oxygenase (COX)-2 inhibitors left standing after others in this class were voluntarily pulled from the market in 2004 because of news of a cardiovascular risk.

Now, evidence in one study indicates the agent can reduce the risk of developing colon cancer by half. However, this drug also nearly doubles the risk of heart problems, according to a study in the New England Journal of Medicine.

Both an accompanying editorial and the authors of the study write that Celebrex may be useful for a small group of patients with the highest cancer risk and few cardiovascular problems.

Because heart attacks are far more common than colon cancer, the risks of u sing celecoxib as a therapeutic agent for colon cancer outweigh the benefits for many people.

"It opens the door to further research in trying to prevent colon cancer, but because of the cardiovascular effects, it's not in itself a complete answer," says Bernard Levin, MD, a senior researcher and vice president for cancer prevention at M.D. Anderson Cancer Center at the University of Texas in Houston.

Early screening for polyps with a colonoscopy is recommended for people with a family history or otherwise at high risk.The results of the research on colon cancer risk reduction first surfaced in late 2004, when heart risks associated with several selective COX-2 inhibitors became apparent.

Since then, data from the studies show Celebrex was particularly effective against advanced polyps, lesions that can become cancerous. The highest dose of the drug reduced the risk of advanced polyps 51% to 66% in the studies.

Heart disease, however, is about five times more common than cancer, even in the high-risk patients with previous polyps included in the study, says Bruce Psaty, MD, PhD, professor of medicine at the University of Washington in Seattle."The cardiovascular risks far outweigh even the most optimistic estimates of the potential benefit on colorectal cancer", says Psaty. He co-wrote an accompanying editorial on the studies.