Objective: Previous data demonstrate an association between cyclooxygenase activity and development of cervical cancer. This review investigates the role of cyclooxygenase-2 (COX-2) in the development of cervical cancer and potential therapeutic options targeting this pathway.
Methods: A literature search was conducted using MEDLINE 1997-2007 utilizing the terms inflammation, cervical cancer, cyclooxygenase, COX-2, indomethacin, cervical intraepithelial neoplasia, and squamous cell cancer. Articles were included based on the quality of the study and pertinence to the topic. Other sources were culled from the references of the articles identified.
Results: Over 150 abstracts were reviewed for inclusion. Studies in vivo and in vitro confirm the role of COX-2 in the development of cervical cancer. In addition, COX-2 overexpression is associated with an increase in angiogenesis markers. Clinical correlation found that COX-2 overexpression in cervical cancer patients is a poor prognostic marker associated with increased risk for recurrent or metastatic disease. Despite early promise, two phase II trials in use of specific COX-2 inhibitors as radio-sensitizers in locally advanced cervical cancer demonstrated increased toxicity with no change in therapeutic effect. Results of studies using COX-2 inhibitors in pre-invasive cervical disease are encouraging.
Conclusions: Treatment of cervical intraepithelial neoplasia with cyclooxygenase inhibitors may provide a medical alternative to surgical therapy.