Patient case: 56-year-old female with basal cell carcinoma; genetic feature: PTCH1

Clinical trial: Celecoxib in Preventing Basal Cell Carcinoma in Patients With Basal Cell Nevus Syndrome

Summary: RATIONALE: Chemoprevention therapy is the use of certain drugs to try to prevent the development of cancer. The use of celecoxib may be an effective way to prevent the development of basal cell carcinoma.
  PURPOSE: Randomized phase II trial to determine the effectiveness of celecoxib in preventing basal cell carcinoma in patients who have basal cell nevus syndrome.

Detailed description: OBJECTIVES:
  -  Determine whether celecoxib prevents the development of basal cell carcinoma in patients with basal cell nevus syndrome.
  OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are randomized to 1 of 2 arms.
  -  Arm I: Patients receive oral celecoxib twice daily.
  -  Arm II: Patients receive oral placebo twice daily. Treatment continues for 2 years in the absence of unacceptable toxicity.
  Patients are followed every 3 months for 3 years.
  PROJECTED ACCRUAL: A total of 60 patients (30 per arm) will be accrued for this study.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed basal cell carcinoma (BCC)
  -  At least 5 prior BCCs AND
  -  At least 4 BCCs within the past year
  -  Meets diagnostic criteria for basal cell nevus syndrome (BCNS)
  -  Any 1 of the following:
  -  More than 2 BCCs or 1 before age 20
  -  Histologically confirmed odontogenic keratocysts of the jaw
  -  3 or more palmar and/or plantar pits
  -  Bilamellar calcification of the falx cerebri (if less than 20 years of age)
  -  Fused, bifid, or markedly splayed ribs
  -  First degree relative with BCNS
  -  PTC gene mutation in normal tissue OR
  -  Any 2 of the following:
  -  Macrocephaly determined after adjustment for height
  -  Congenital malformations (e.g., cleft lip or palate, frontal bossing, "coarse face", or moderate or severe hypertelorism)
  -  Skeletal abnormalities (e.g., Sprengel deformity, marked pectus deformity, or marked syndactyly of the digits)
  -  Radiological abnormalities (e.g., bridging of the sella turcica, vertebral anomalies, modeling defects of the hands and feet, or flame-shaped lucencies of the hands or feet)
  -  Ovarian fibroma
  -  Medulloblastoma
  PATIENT CHARACTERISTICS:
  Age:
  -  18 to 75
  Performance status:
  -  Not specified
  Life expectancy:
  -  Not specified
  Hematopoietic:
  -  WBC greater than 3,000/mm^3
  -  Platelet count greater than 125,000/mm^3
  -  Hemoglobin greater than 12.0 g/dL (women)
  -  Hemoglobin greater than 13.0 g/dL (men)
  -  No significant coagulation defect
  Hepatic:
  -  Bilirubin normal
  -  ALT/AST no greater than 1.5 times upper limit of normal (ULN)
  -  No chronic or acute hepatic disorder
  Renal:
  -  Creatinine no greater than 1.5 times ULN
  -  BUN normal
  -  Electrolytes within normal
  -  No chronic or acute renal disorder
  Cardiovascular:
  -  No congestive heart failure
  Gastrointestinal:
  -  No active gastrointestinal disease
  -  No inflammatory bowel disease
  -  No chronic or acute pancreatic disorder
  -  No history of gastrointestinal ulceration allowed except with permission of primary care physician
  -  No esophageal, gastric, pyloric channel, or duodenal ulceration within the past 30 days
  -  Stool hematest normal
  Other:
  -  No prior invasive malignancy within the past 5 years except nonmelanoma skin cancer, stage I cervical cancer, stage 0 chronic lymphoblastic leukemia, or medulloblastoma
  -  No hypersensitivity to COX-2 inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), salicylates, or sulfonamides
  -  No other condition that would preclude study involvement
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  Not specified
  Chemotherapy:
  -  At least 2 weeks since prior topical agents as chemoprevention
  -  At least 1 year since other prior chemotherapy
  Endocrine therapy:
  -  At least 1 month since prior oral or IV corticosteroids
  -  At least 6 months since prior inhaled corticosteroid use for longer than 4 weeks
  -  At least 2 weeks since prior topical glucocorticoids
  -  No concurrent topical glucocorticoids
  -  Concurrent oral and IV corticosteroid use of less than 2 weeks within 6 months allowed
  -  Concurrent inhaled corticosteroid use of less than 4 weeks within 6 months allowed
  Radiotherapy:
  -  Not specified
  Surgery:
  -  Not specified
  Other:
  -  At least 2 weeks since prior topical retinoids or alpha-hydroxy acids (e.g., glycolic acid or lactic acid)
  -  At least 2 weeks since prior topical medications
  -  At least 30 days since prior investigational agents
  -  At least 2 months since prior NSAIDs given more than 3 times/week
  -  At least 2 months since prior aspirin dose of more than 100 mg/day given more than 3 times/week
  -  At least 6 months since prior oral retinoids
  -  No concurrent chronic NSAIDs (more than 3 times per week for at least 2 weeks)
  -  No concurrent aspirin dose of more than 100 mg/day
  -  No concurrent topical medications
  -  No concurrent fluconazole
  -  No concurrent lithium
  -  No concurrent retinoids (including topical administration) or alpha-hydroxy acids
  -  No other concurrent investigational agents

Relevance to patient case: definitely relevant