title: Clinical Profile of Cyclooxygenase-2 Inhibitors in Treating Non-Small Cell Lung Cancer: A Meta-Analysis of Nine Randomized Clinical Trials.
abstract: BACKGROUND
  Evidence on the benefits of combining cyclooxygenase-2 inhibitor (COX-2) in treating non-small cell lung cancer (NSCLC) is still controversial. We investigated the efficacy and safety profile of cyclooxygenase-2 inhibitors in treating NSCLC.
  
  
  METHODS
  The first meta-analysis of eligible studies was performed to assess the effect of COX-2 inhibitors for patients with NSCLC on the overall response rate (ORR), overall survival (OS), progression-free survival (PFS), one-year survival, and toxicities. The fixed-effects model was used to calculate the pooled RR and HR and between-study heterogeneity was assessed. Subgroup analyses were conducted according to the type of COX-2 inhibitors, treatment pattern, and treatment line.
  
  
  RESULTS
  Nine randomized clinical trials, comprising 1679 patents with NSCLC, were included in the final meta-analysis. The pooled ORR of patients who have NSCLC with COX-2 inhibitors was significantly higher than that without COX-2 inhibitors. In subgroup analysis, significantly increased ORR results were found on celecoxib (RR = 1.29, 95% CI: 1.09, 1.51), rofecoxib (RR = 1.61, 95% CI: 1.14, 2.28), chemotherapy (RR = 1.40, 95% CI: 1.20, 1.63), and first-line treatment (RR = 1.39, 95% CI: 1.19, 1.63). However, COX-2 inhibitors had no effect on the one-year survival, OS, and PFS. Increased RR of leucopenia (RR = 1.21, 95% CI: 1.01, 1.45) and thrombocytopenia (RR = 1.36, 95% CI: 1.06, 1.76) suggested that COX-2 inhibitors increased hematologic toxicities (grade ≥ 3) of chemotherapy.
  
  
  CONCLUSIONS
  COX-2 inhibitors increased ORR of advanced NSCLC and had no impact on survival indices, but it may increase the risk of hematologic toxicities associated with chemotherapy.
authors.affiliation: Department of Respiratory medicine, The first College of Clinical Medicine science, Three Gorges University, Yichang, 443003, People's Republic of China.
authors.forename: Yuan Yuan
authors.initials: YY
authors.lastname: Zhou
authors.affiliation: Department of Respiratory medicine, The first College of Clinical Medicine science, Three Gorges University, Yichang, 443003, People's Republic of China.
authors.forename: Zhi Gang
authors.initials: ZG
authors.lastname: Hu
authors.affiliation: Department of Respiratory medicine, The first College of Clinical Medicine science, Three Gorges University, Yichang, 443003, People's Republic of China.
authors.forename: Fan Jun
authors.initials: FJ
authors.lastname: Zeng
authors.affiliation: Department of Respiratory medicine, The first College of Clinical Medicine science, Three Gorges University, Yichang, 443003, People's Republic of China.
authors.forename: Jiao
authors.initials: J
authors.lastname: Han
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D052246:Cyclooxygenase 2 Inhibitors