Research targets evolution of CIN.(News)

LAS VEGAS -- Chemopreventive therapeutic agents may be able to alter the molecular changes that occur in the progression from preinvasive to invasive cervical disease, Dr. Janet S. Rader said at a meeting of the American Society for Colposcopy and Cervical Pathology.

"Chemoprevention for cervical cancer is a priority," said Dr. Rader, who is a professor of obstetrics and gynecology at Washington University in St. Louis. "There are no standard-of-care treatments now for cervical dysplasia, but there are several ongoing clinical trials."

In chemoprevention trials in the United States, researchers are examining the efficacy of a diverse array of agents including a topical immunomodulator, a cell-cycle inhibitor that can induce apoptosis, an amino-bisphosphonate, and celecoxib.

The cyclooxygenase-2 (COX-2) inhibitors are key enzymes in the conversion of arachidonic acid to prostaglandins, and the COX-2 isoform has been associated with inflammation and carcinogenesis.

Some data indicate an inverse relationship between the risk of cancer and the intake of COX-2 inhibitors.

Investigators in the Phase II Randomized Study of Celecoxib in Patients With Cervical Intraepithelial Neoplasia 3 are studying the efficacy of celecoxib in terms of achieving histologic complete or partial response, as well as its toxicity in these patients.

"Nonsurgical treatment for this disease is of benefit due to unknown effects of surgery on future pregnancy outcomes," said Dr. Rader. "The ongoing chemoprevention studies are open and accruing patients, and all are worth evaluating, including COX-2 inhibitors."