Celecoxib in Preventing Polyps in Patients Who Have Undergone Surgery for Stage I Colon Cancer

Celecoxib Polyp Prevention Trial in Participants With Resected Stage I Colon Cancer

RATIONALE: Chemoprevention therapy is the use of certain drugs to try to prevent the development of cancer. It is not yet known whether celecoxib is effective in preventing polyps in patients with colon cancer.

PURPOSE: Randomized phase III trial to study the effectiveness of celecoxib in preventing the development of polyps in patients who have undergone surgery for stage I colon cancer.

Study Overview

• Status: Terminated
• Conditions: Colorectal Cancer
• Intervention / Treatment: Other: placebo; Drug: Celecoxib

Detailed Description

OBJECTIVES:

Primary

• Compare celecoxib vs placebo, in terms of decreasing the incidence of adenomatous polyps of the colon and rectum, in patients with resected stage I adenocarcinoma of the colon.

Secondary

• Compare disease-free survival of patients treated with these regimens.
• Compare the effect of these regimens on self-reported symptoms and health-related quality of life of these patients.
• Compare the quality of life of patients treated with these regimens.
• Compare the benefits of celecoxib in patients with primary tumors or polyps that express cyclo-oxygenase-2 (COX-2) with those that do not express COX-2.
• Compare the expression of signaling targets such as serine/threonine AKT, extracellular signal-regulated kinase 2 (ERK2), and endoplasmic reticulum Ca+2- ATPases in the index tumor and polyps.
• Determine the toxicity and safety of celecoxib in these patients.

OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to gender, tumor stage (T1 vs T2), age (≤ 49 vs 50 to 59 vs ≥ 60 years), and current aspirin use (yes vs no). Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients receive oral celecoxib twice daily for 3 years.
• Arm II: Patients receive oral placebo twice daily for 3 years. In both arms, treatment continues in the absence of unacceptable toxicity or the diagnosis of invasive colon cancer, carcinoma in situ of the colon or rectum, or a non-colon primary cancer.

Quality of life is assessed at baseline and then at 6, 12, 24, 36, and 42 months.

Patients are followed at 6 months and at 2 years.

PROJECTED ACCRUAL: A total of 1,200 patients (600 per treatment arm) will be accrued for this study within 2.5 years.

• Study Type: Interventional
• Enrollment (Actual): 18
• Phase: Phase 3

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15215
      • Allegheny General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

DISEASE CHARACTERISTICS:

• Histologically confirmed adenocarcinoma of the colon

  • Stage I disease
  • Distal border of tumor ≥ 12 cm from the anal verge
• Tumor completely resected within the past 90 days

• Must have undergone a preoperative or postoperative colonoscopy to the cecum (or small bowel anastomosis) within the past 90 days

  • All observed polyps must have been removed

• Patients with a history suggestive of hereditary non-polyposis colorectal cancer (HNPCC) must have a normal microsatellite instability status by immunohistochemistry or polymerase chain reaction

  • Patients with family history of colon cancer who have not been diagnosed with HNPCC are eligible
• No prior familial adenomatous polyposis
• No prior invasive cancer or carcinoma in situ of the colon or rectum
• No clinical or radiologic evidence of metastatic disease

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• Zubrod 0-1

Life expectancy

• At least 10 years

Hematopoietic

• Complete blood count normal
• Platelet count normal

Hepatic

• Aspartate aminotransferase (AST) normal
• Bilirubin normal
• Alkaline phosphatase normal

Renal

• Creatinine normal

Cardiovascular

• No active ischemic heart disease
• No New York Heart Association class III or IV heart disease
• No myocardial infarction within the past 6 months
• No symptomatic arrhythmia
• No symptomatic peripheral vascular disease or carotid disease that would preclude study participation

Pulmonary

• No aspirin-sensitive asthma

Gastrointestinal

• No history of inflammatory bowel disease
• No history of upper gastrointestinal bleeding
• No history of duodenal or gastric ulcer

Other

• No known hypersensitivity to any COX-2 inhibitor, NSAIDs, aspirin, or sulfonamides
• No non-colorectal malignancy within the past 5 years except carcinoma in situ of the cervix, melanoma in situ, or basal cell or squamous cell skin cancer
• No other disease that would preclude study participation
• No psychiatric disorders, including history of clinical depression or addictive disorders, that would preclude giving informed consent or long-term compliance
• No rheumatologic or skeletal disorders requiring chronic NSAIDs or steroid therapy
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Not specified

Chemotherapy

• Not specified

Endocrine therapy

• Not specified

Radiotherapy

• Not specified

Surgery

• See Disease Characteristics

Other

• No other concurrent investigational agents for colon cancer

• No concurrent chronic use of other cyclo-oxygenase-2 (COX-2) inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), or salicylates (e.g., aspirin)

  • Chronic use is defined as use for more than an average of 3 days per month

    • Concurrent NSAIDs allowed for up to 10 consecutive days for temporary relief due to inflammatory syndromes, injury, or postoperative pain
  • Cardioprotective doses of aspirin (≤ 81 mg/day or 325 mg every other day) allowed
• No concurrent fluconazole or lithium

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Arm 1: placebo; one placebo capsule taken orally twice a day for 3 years	Drug: Celecoxib; Other Names: Celebrex
Experimental: Arm 2: celecoxib; one 400 mg capsule taken orally twice a day for 3 years	Other: placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
To determine whether celecoxib 400 mg bid for 3 years will decrease the incidence of adenomatous polyps of the colon and rectum in participants with Stage I adenocarcinoma of the colon.	60 months

Secondary Outcome Measures

Outcome Measure	Time Frame
To access whether celecoxib will increase disease-free survival.	60 months
To access whether celecoxib therapy affects self-reported symptoms and health-related quality of life.	60 months
To describe the quality of life in early stage colon cancer patients.	42 months
To evaluate if the benefits from celecoxib are more pronounced in a cohort of participants whose primary colon tumors and polyps express COX-2.	60 months
To examine the expression of signaling targets such as serine/threonine kinase (AKT) extracellular signal-regulated kinase (ERK2), and endoplasmic reticulum Ca2+-ATPases in the index tumor and polyps.	60 months
To monitor the toxicity and safety of celecoxib in this population.	60 months

Collaborators and Investigators

• Sponsor: NSABP Foundation Inc
• Collaborators: National Cancer Institute (NCI)

Study record dates

Study Major Dates

• Study Start: July 1, 2004
• Primary Completion (Actual): April 1, 2006
• Study Completion (Actual): April 1, 2006

Study Registration Dates

• First Submitted: July 8, 2004
• First Submitted That Met QC Criteria: July 9, 2004
• First Posted (Estimate): July 12, 2004

Study Record Updates

• Last Update Posted (Estimate): January 7, 2013
• Last Update Submitted That Met QC Criteria: January 4, 2013
• Last Verified: January 1, 2013

More Information

Terms related to this study

• Keywords: adenocarcinoma of the colon; stage I colon cancer
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Intestinal Neoplasms; Colorectal Neoplasms; Colonic Neoplasms; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Peripheral Nervous System Agents; Enzyme Inhibitors; Analgesics; Sensory System Agents; Anti-Inflammatory Agents, Non-Steroidal; Analgesics, Non-Narcotic; Anti-Inflammatory Agents; Antirheumatic Agents; Cyclooxygenase Inhibitors; Cyclooxygenase 2 Inhibitors; Celecoxib
• Other Study ID Numbers: NSABP P-3; NSABP-P-3