The role of celecoxib for colorectal cancer treatment: a systematic review

Xiaohan Zhou, Xiuyun Wang, Yaqin Zhao, Cheng Yi


Background: Some evidence has suggested that the Cox-2 inhibitor, celecoxib, might improve the survival outcomes in cancer patients. However, the association between celecoxib use and treatment response in colorectal cancer (CRC) patients remains controversial. Thus, a summary on current evidence was performed.
Methods: We conducted an electronic search using (PubMed, Web of Science, Embase, and CNKI) to identify relevant peer-reviewed articles, up to March 2018. Eligible study designs included randomized controlled trials (RCTs) and uncontrolled trials (UCTs) with the single experimental arm. The included trials evaluated the effect of adding celecoxib to conventional treatments for patients with CRC on overall response rate (ORR), disease control rate (DCR), pathological response, survival indices, and toxicities.
Results: The final analysis included 12 trials with a total of 621 patients. In this study, a qualitative summary and meta-analysis was performed due to insufficient RCTs. The addition of celecoxib showed improvement of pathological response but had no effects on ORR (RR =1.09; 95% CI, 0.62–1.92; P=0.76) and DCR (RR =1.09; 95% CI, 0.94–1.27; P=0.25). The impact of celecoxib on survival indices remains unclear. Meta-analysis on toxicities suggests that celecoxib is well tolerated with a decreased risk of oral mucositis (RR =0.35; 95% CI, 0.18–0.67; P=0.002).
Conclusions: Results showed the potential benefits of celecoxib in the treatment of resectable CRC compared with chemotherapy or chemoradiotherapy alone, but there were no effects on ORR/DCR or survival indices. The safety profile was identified in the meta-analysis among CRC patients. The benefit versus harm needs to be carefully considered when celecoxib is recommended in patients with a history of cardiac diseases. In this review, part of the evidence was evaluated from non-RCTs, so further well-designed RCTs in this field are urgently required to confirm our finding.