Clinical Response in Nasopharyngeal Carcinoma with Combined Therapy of Concurrent Chemoradiotherapy and NSAIDs: Etoricoxib vs Piroxicam

Abstract

Introduction: Many studies have shown the effects of cyclooxygenase-2 (COX-2) inhibitors as chemopreventing and radiosensitizer. The effects of these drugs on NPC is unknown. We tried to evaluate the efficacy of etoricoxib (selective) and piroxicam (non-selective) in nasopharyngeal carcinoma patients who underwent concurrent chemoradiotherapy with the aim to gain a better clinical response. Methods & Findings: A randomized, double blind clinical trial was conducted on NPC patients who underwent concurrent chemoradiotherapy. Total 25 subjects completed the study, they were assigned into 3 groups to receive either Etoricoxib 60 mg, Piroxicam 20 mg or placebo once daily per oral. We evaluated clinical responses in 8 subjects given Etoricoxib, 8 Piroxicam and 9 placebo. There was a significant difference in primary tumor size (p = 0.026), lymph node enlargement (p = 0.024) and tumor stage (p = 0.024) pre and post concurrent chemoradiotherapy in the group combined with Etoricoxib. Meanwhile, Piroxicam group showed equal results with the placebo, in which a significant difference was only found in lymph node enlargement and clinical stage but not in primary tumor size.Conclusion: Better clinical response is well achieved in nasopharyngeal carcinoma by combining a selective COX-2 inhibitor, Etoricoxib, with concurrent chemoradiotherapy.

Keyword: Etoricoxib, concurrent chemoradiotherapy, clinical response