Gefitinib and celecoxib in advanced metastatic gastrointestinal tumors: a pilot feasibility study

Abstract

Background: This pilot, open-label study examined the safety and tolerability (primary objective) and efficacy (secondary objective) of gefitinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, in combination with celecoxib, a cyclooxygenase-2 (COX-2) inhibitor, in patients with advanced or refractory gastrointestinal (GI) tumors of epithelial origin.

Methods: Patients were administered gefitinib (250 mg/day) plus celecoxib (400 mg twice daily). In the event of toxicity, dose interruptions were permitted and a single celecoxib dose reduction was allowed.

Results: Thirty patients (median age 60 years) with primary colorectal (25 patients), pancreatic (3 patients), esophageal (1 patient), or gall bladder (1 patient) tumors were recruited, 29 of whom had received prior chemotherapy. Adverse events (AEs) were generally mild and consisted mainly of acne, diarrhea, and nausea. Few severe AEs were noted. There were no withdrawals or deaths due to AEs. Dose reductions for celecoxib were reported for five patients, in three cases due to toxicity. Stable disease was confirmed in 12 patients (40%), with progressive disease in 18 patients (60%).

Conclusions: After study completion, safety issues relating to the long-term use of COX-2 inhibitors have been raised. However, in this pilot study, the combination of gefitinib and celecoxib was generally well tolerated in patients with advanced GI cancer.

Keywords: Gefitnib; celecoxib; gastrointestinal cancer (GI cancer).

Figure 1

(A) TTP and (B) overall survival in 30 patients with GI tumors treated with gefitinib (250 mg/day) and celecoxib (400 mg bid). bid, twice daily; CI, confidence interval; GI, gastrointestinal; TTP, time to progression.

Figure 2

(A) EGFR and (B) COX-2 immuno-expression, and overall survival in patients with GI tumors. COX-2, cyclo-oxygenase-2; EGFR, epidermal growth factor receptor; GI, gastrointestinal.