The influence of fluticasone inhalation on markers of carcinogenesis in bronchial epithelium.
BACKGROUND
Bronchial epithelium exposed to cigarette smoke undergoes a series of histologic changes that may ultimately lead to invasive cancer. Inhaled corticosteroids reduce the number of lung tumors developing in rats exposed to cigarette smoke.


OBJECTIVE
We studied the effect of inhaled fluticasone on premalignant lesions in smokers and patients curatively treated for head and neck cancer or lung cancer.


METHODS
Participants were screened for premalignant lesions by bronchoscopy. Biopsies were taken from three to five locations and classified using WHO criteria. In case of a metaplasia index of > 15%, participants were randomized to receive a powder inhalation device containing either fluticasone 500 microg or a placebo, to be used twice a day. After 6 months, biopsies were obtained from the same locations as previously sampled. Efficacy of treatment was assessed by reversal of metaplasia/dysplasia; secondary endpoints were reversal of increased p53 and KI-67 immunoreactivity and expression of human telomerase reverse transcriptase.


RESULTS
Of the 201 subjects that were screened, 108 were included. Mean age was 53 yr (35-71), mean number of pack-years 48 (18-99), mean metaplasia index 48%, and 32% had some degree of dysplasia at baseline. The two treatment arms did not differ with respect to response or change in either metaplasia index or the expression of the markers p53, KI-67, or human telomerase reverse transcriptase.


CONCLUSIONS
Inhaled fluticasone in a dose of 500 mug twice a day does not affect the natural course of premalignant lesions in the central airways.
van den Berg
Remco M
RM
Department of Pulmonology, VU Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
van Tinteren
Harm
H
van Zandwijk
Nico
N
Visser
Christine
C
Pasic
Arifa
A
Kooi
Clarissa
C
Sutedja
Thomas G
TG
Baas
Paul
P
Grünberg
Katrien
K
Mooi
Wolter J
WJ
Snijders
Peter J F
PJ
Postmus
Pieter E
PE
Smit
Egbert F
EF
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000730:Androstadienes / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D014408:Biomarkers, Tumor / Q000032:analysis*; D001980:Bronchi / Q000187:drug effects / Q000473:pathology; D001984:Bronchial Neoplasms / Q000473:pathology / Q000517:prevention & control*; D002471:Cell Transformation, Neoplastic / Q000139:chemically induced / Q000187:drug effects* / Q000473:pathology; D004848:Epithelium / Q000187:drug effects / Q000473:pathology; D005260:Female; D000068298:Fluticasone; D006801:Humans; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012907:Smoking; D017211:Treatment Failure; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53; D000068298:Fluticasone