- The Washington Times - Sunday, March 31, 2002

ASSOCIATED PRESS
Scientists are hard at work recycling Celebrex and Vioxx, the red-hot inflammation pills taken by tens of millions for arthritis. They have an unlikely new use in mind, one maybe even more important than soothing throbbing joints.
Their goal: Prove these medicines prevent cancer and perhaps even help cure it.
While there are good scientific reasons to think they are onto something, the experiments to settle the question are not finished, and the optimists could be dead wrong. Nevertheless, cancer researchers and pharmaceutical executives entertain fantasies of a breakthrough role for an off-the-shelf medicine.
Among them is Dr. Philip Needleman, who has spent more than a decade first at Washington University and now at Pharmacia, where he is research director developing Celebrex as an arthritis medicine. Just three years on the market, it is the 10th-biggest-selling prescription drug in the United States.
But in his vision, that success is a mere warm-up. "People ask what gets me juiced," Dr. Needleman says. "It's the possibility that in five or 10 years, someone will say, 'Oh yes. Celebrex. That's also used in arthritis.'"
Many in industry, government and medical schools seem to share his daydream. In a world where people are used to disappointment, hopes run high that Celebrex and its rivals can be redirected against the most feared disease of all.
The drugs block production of a chemical called COX-2, which triggers pain and inflammation and may also fuel the growth of cancer, where it is often found in abundance.
The first big test will be in preventing colon cancer, second only to lung cancer as a killer. Three big studies involving about 6,000 volunteers will see if Celebrex and Vioxx stop precancerous growths in the colon. The results should be known within two years.
"If we could reduce the incidence of this disease by half, what an incredible contribution that would be," muses Dr. Monica Bertagnolli of Brigham and Women's Hospital in Boston, director of one of the studies. "That's what is driving all of this."
But that might be just the start. Experiments on lab animals strongly suggest the arthritis drugs could also help cure cancer, especially if combined with chemotherapy or radiation. Whether the approach will actually work is not clear, because testing Celebrex on cancer patients has just begun, but many research teams are joining in.
In fact, Dr. Andrew Dannenberg, director of cancer prevention at Cornell's Weill Medical College, estimates there may be as many as 100 separate cancer studies involving these drugs worldwide.
"When in the history of drug development has a drug moved from arthritis to cancer prevention and then been fast-tracked into cancer therapy?" he asks? "It's completely unprecedented."
One of these studies will examine whether Celebrex shows any sign of warding off lung cancer in 20-year, pack-a-day smokers. Many others are testing the drugs in people with cancer of the breast, lung, esophagus, skin, prostate and bladder.
One reason for doctors' willingness to try the drugs is their apparent safety. Celebrex and Vioxx known as COX-2 inhibitors were designed to be easier on the stomach than aspirin and other inflammation fighters. Their lack of frequent side-effects makes them unique in cancer, a field not known for gentle therapies.
"Everyone is looking to integrate COX-2 inhibitors into every aspect of cancer treatment, because we don't expect them to be toxic," says Dr. Adam Dicker of Jefferson Medical College in Philadelphia.
A major sponsor of this research is the National Cancer Institute, which oversees Dr. Bertagnolli's colon cancer prevention study plus many of the smaller treatment experiments with Celebrex.
Dr. Ernest Hawk, the agency's chief of gastrointestinal research, says the government is betting on the drug because of the overlapping lines of evidence from epidemiology, animal experiments and more that the approach should work.
"What stands out is the weight of the evidence," Dr. Hawk says. "I can't think of any class of drugs that have this much going for them, especially in colon cancer. It's the consistency of the story."


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