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AACR: NSAIDS-Related Heart Deaths Wipe Out Advantage in Oral Cancer Treatment By Ed Susman ANAHEIM, CA -- April 19, 2005 -- Cigarette smokers appear to cut in half their risk of dying due to oral cancer if they use non-steroidal anti-inflammatory drugs (NSAIDS), but these agents also double their risk of dying due to heart disease. Jon Sudbo, MD, cancer researcher, Norwegian Radium Hospital, Oslo, Norway, reported the findings here on April 18th at the 96th annual meeting of the American Association for Cancer Research. There were 42 cardiovascular deaths among 263 high-risk long-term NSAID users who smoked the equivalent of two packs of cigarettes per day for 15 years, and 41 cardiovascular deaths among 562 high-risk controls, Dr. Sudbo. The findings illustrate another cautionary tale about the risks associated with chemoprevention of cancer, said Raymond DuBois, MD, director, Vanderbilt-Ingram Cancer Center, and professor of medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States, who moderated an AACR press conference where the findings were discussed. "You don't want to do something that will make persons worse," Dr. DuBois said. The protective effect of NSAIDs against oral cancers works equally well for aspirin, Advil, Motrin (ibuprofen), Aleve (naproxen), Indocin (indomethacin), Feldene (piroxicam) and Orudis (ketoprofen). The researchers found that there was no risk reduction associated with Tylenol (acetaminophen) use, Dr. Sudbo says. "We expected that, since the protection from NSAIDs comes from [cyclooxygenase]-2 inhibition and acetaminophen has no inhibitory effect on COX," he explained. Dr. Sudbo and colleagues are going forward with a study of Celebrex (celecoxib) 400 mg twice daily in patients with aneuploid oral leukoplakia, which is an aggressive type of oral cancer with a 75% mortality rate. "A mortality rate that high will allow a realistic comparison with the risk of cardiovascular mortality," he said. In the study, use of NSAIDs reduced the risk of developing oral cancer in the high-risk smokers by 53%, a finding that was statistically significant at the P < .0001 level. A 47% reduction in oral cancer was seen in people who took NSAIDs daily for 5 years; a 70% reduction was seen in those on the drugs for more than 15 years. Aspirin had the lowest risk for cardiovascular death, but the number of patients taking this drug was too small to calculate significance, Dr. Sudbo said. [Presentation title: Non-Steroidal Anti-Inflammatory Drugs, Tobacco and the Risk of Oral Cancer. Abstract 4377] E-mail this page to a friend or colleague! To print, use this version