Phase II study of docetaxel and celecoxib, a cyclooxygenase-2 inhibitor, in elderly or poor performance status (PS2) patients with advanced non-small cell lung cancer

Abstract

Introduction: The utility of two-drug chemotherapy regimens in elderly or performance status (PS 2) patients with advanced non-small cell lung cancer (NSCLC) remains to be established. Preclinical studies suggested that celecoxib, a Cyclooxygenase-2 inhibitor, has antitumor activity in NSCLC and can enhance the activity of chemotherapy drugs. We conducted a phase II study to evaluate the efficacy of the combination of weekly docetaxel and celecoxib in advanced NSCLC patients, who were either elderly (> or =70 years) or PS2.

Methods: Patients with stage IIIB (with pleural effusion) or IV NSCLC who were > or =70 years and had a PS of 0-2 or patients of any age with a PS of 2 were included. Patients should have been off any nonsteroidal anti-inflammatory drug for 30 continuous days before study enrollment. Patients were treated with weekly docetaxel 36 mg/m i.v. on days 1, 8, 15 of a 28 day cycle and Celecoxib 400 mg po twice daily. Disease assessment was performed after every two cycles. The study design required 39 patients.

Results: Study was terminated after 34 patients were enrolled due to safety concerns regarding celecoxib. Thirty patients were evaluable. The response rate was 15%. The median progression free survival and median survival were 2.3 months and 5.0 months, respectively. The median survival of patients > or =70 years old with a PS of 0-1 was 8.3 months and the median survival of PS2 patients was 2.8 months. The combination was well tolerated with fatigue as the most common adverse effect. Two patients developed arterial thrombotic events.

Conclusion: In these 'special populations' of patients with advanced NSCLC, the addition of celecoxib to docetaxel did not seem to improve the outcome compared with single agent docetaxel.

Figures

FIGURE 1

The Kaplan-Meier estimate of progression free survival (PFS) in the 34 patients. The dashed lines represent the 90% confidence interval (CI) about each successive estimate of the progression free rate.

FIGURE 2

The Kaplan-Meier estimate of overall survival (OS) in the 34 patients. The dashed lines represent the 90% confidence interval (CI) about each successive estimate of the survival rate. The 12-month OS rate is 17%, with 90% CI of 0.06– 0.27.

FIGURE 3

The Kaplan-Meier estimate of overall survival (OS) in the 15 elderly patients with PS 0–1. The dashed lines represent the 90% confidence interval (CI) about each successive estimate of the survival rate. The 12-month OS rate is 18%, with 90 CI of 0.02–0.34.