Celecoxib vs placebo in combination with chemotherapy for non-small cell lung cancer: A systematic review and meta-analysis of randomized controlled trials.

Abstract

e20666 Background: Non-small cell lung cancer (NSCLC) is the leading cause of lung cancer-related mortality, with chemotherapy remaining a cornerstone of treatment. Celecoxib, a selective COX-2 inhibitor, can enhance chemotherapy by reducing inflammation and tumor growth. However, its clinical benefit when combined with chemotherapy for NSCLC remains unclear. This systematic review and meta-analysis aims to assess the efficacy of Celecoxib versus placebo when used alongside chemotherapy in NSCLC patients, providing a clearer understanding of its role in treatment. Methods: A comprehensive search of PubMed, Embase, and Web of Science was conducted from inception till January 2025. The primary outcomes analyzed were progression-free survival (PFS) at 30 months and overall survival (OS) at 30 months. Adverse events were categorized into hematological and non-hematological events. Hematological adverse events included grade 3 and 4 anemia, grade 3 and 4 leukemia, and grade 3 and 4 thrombocytopenia. Non-hematological adverse events included grade 3 and 4 diarrhea and grade 3 and 4 vomiting. Data were analyzed using a random-effects model in RevMan (version 5.4.1). Results: This meta-analysis of five randomized controlled trials (RCTs) involving 1,402 patients compared Celecoxib-based therapy (n=698) with placebo (n=704). The progression-free survival (PFS) analysis at 30 months favored placebo (RR: 0.97, 95% CI: 0.94–1.00, p=0.02). In contrast, overall survival (OS) analysis at 30 months showed no significant difference between Celecoxib and placebo (RR: 1.21, 95% CI: 0.48–3.06, p=0.68). For adverse events, grade 3 and 4 anemia was more frequent in the Celecoxib group, with placebo showing a benefit (RR: 1.51, 95% CI: 1.08–2.10, p=0.02). No statistical difference was seen for grade 3 and 4 leukopenia (RR: 1.25, 95% CI: 0.99–1.56, p=0.06), grade 3 and 4 thrombocytopenia (RR: 1.27, 95% CI: 0.97–1.67, p=0.09), grade 3 and 4 diarrhea (RR: 0.94, 95% CI: 0.75–1.17, p=0.56), or grade 3 and 4 vomiting (RR: 0.71, 95% CI: 0.31–1.62, p=0.41). Conclusions: This meta-analysis suggests that adding Celecoxib to chemotherapy in NSCLC patients does not significantly improve overall or progression-free survival. While there was a notable increase in grade 3 and 4 anemia in the Celecoxib group, there was no significant difference in other adverse events. Given the lack of survival benefits and the potential for adverse effects, the clinical role of Celecoxib as an adjunct to chemotherapy in NSCLC remains uncertain. Further studies are needed to better define its place in treatment regimens for this patient population.