Chemoprevention therapy is the use of certain drugs to try to prevent the development of cancer. The use of celecoxib has been approved for use in reducing the number of adenomatous colorectal polyps in familial adenomatous polyposis (FAP). It is not known whether there is a clinical benefit from a reduction in the number of colorectal polyps in FAP patients. The use of celecoxib may be an effective way to prevent the development of sporadic adenomatous polyps, precursors of colorectal cancer. This randomized phase III trial is studying celecoxib to see how well it works compared to a placebo in preventing the development of adenomatous colorectal polyps in patients who have had at least one polyp removed.
PRIMARY OBJECTIVES: I. Determine the safety and efficacy of celecoxib in reducing the occurrence of new sporadic adenomatous polyps (SAP) in the colon and rectum in patients who have undergone polypectomy for previous SAP. OUTLINE: This is a randomized, double blind, placebo controlled study. Patients are entered on one of two treatment arms. Arm I: Patients receive celecoxib twice a day for 3 years. Arm II: Patients receive placebo twice a day for 3 years. Patients are evaluated for adenomatous colorectal polyps at 1 and 3 years. PROJECTED ACCRUAL: Over 1000 patients will be accrued for this study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
1,170
Brigham and Women's Hospital
Boston, Massachusetts, United States
Percentage of subjects with newly detected adenomas, and will be estimated using the life table method for each treatment group
Will be estimated using the life table method for each treatment group and compared using a life-table extension of the Mantel-Haenszel statistics with stratification for aspirin use. Additional analysis will be performed for the primary endpoint to adjust for the baseline prognostic factors and colon cancer/adenoma risk factors using, for example, proportional hazard model or logistic model.
Time frame: Year 3 (cumulative for year one and year three)
Percentage of patients with adenomas, aspirin use at baseline, and covariates
This will be derived by treatment group (celecoxib 400 mg bid, celecoxib 200 mg bid, or placebo) and low-dose aspirin use at baseline and in relationship to the patient's adenoma history at the year 3 colonoscopy. Of particular interest is whether the conditional rate of adenomas at year 5 differs by treatment group and strata with control for potential differences in these groups by adenoma history at year 3 colonoscopy, age, sex, family history of colorectal cancer, smoking, concomitant use of NSAID's, total time on study drug, and other covariates.
Time frame: Year 5
The number of adenomas identified per patient
Will be compared between the Celecoxib treated arm and the Placebo treated arm using nonparametric analogs of the t-test (Wilcoxon rank sum or similar statistics). Poisson regression will also be used to assess whether the number of adenomas detected at surveillance colonoscopy differs between the celecoxib and placebo groups.
Time frame: Year 1
The number of adenomas identified per patient
Will be compared between the Celecoxib treated arm and the Placebo treated arm using nonparametric analogs of the t-test (Wilcoxon rank sum or similar statistics). Poisson regression will also be used to assess whether the number of adenomas detected at surveillance colonoscopy differs between the celecoxib and placebo groups.
Time frame: Year 3
The highest histopathologic grade, largest size, and polyp burden (sum of the polyp diameters) of the colorectal adenomas
Will be analyzed using ordinal categorical data analysis methods.
Time frame: Up to 3 years
The number of advanced adenomas (adenoma of size 1.0 cm or larger, any villous histology, high grade dysplasia, or invasive cancer) detected at surveillance
Time frame: Up to 3 years
Adenoma findings at year 1 colonoscopy as predictors of adenoma findings at year 3 colonoscopy
The findings of the Year 1 surveillance colonoscopy will also be evaluated as whether they can be used in future studies as a surrogate endpoint for the primary outcomeof the cumulative percentage of patients with newly detected adenomas at either the year one and/or at the Year 3 colonoscopy surveillance.
Time frame: Year 3
Adverse events will be coded using the MedRA dictionary
The safety analyses will consist of displays of the distribution by treatment group and adverse event category of the numbers of subjects reporting at least one episode of a specific adverse event (incidence table) and the severity and attribution to study drug of each episode reported (severity and attribution table). The proportion of subjects withdrawn due to adverse events will also be summarized.
Time frame: Up to 3 months post-treatment
Mean number of adenomas detected at year 5, as well as the distribution of number of adenomas, and the adenoma burden based on the sum of the adenoma diameters at year 5
Time frame: Year 5
Adverse events coded using the MedRA dictionary
Time frame: Up to 5 years
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