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Celecoxib and Myrtol: A Novel Therapy for Recurrent Appendiceal Mucinous Neoplasms With Extensive Peritoneal
Mason Vierra1, Ankit Dhiman2,3, Hunter D D Witmer3
1University of Chicago Pritzker School of Medicine.
Background:
Unresectable appendiceal mucinous neoplasms (AMNs) with extensive peritoneal dissemination cause significant morbidity and have limited treatment options. We evaluated a novel combination of Celecoxib and Myrtol in treating such AMNs.
Methods:
Patients with recurrent AMNs with extensive peritoneal disease treated with a daily regimen of 200 mg Celecoxib and 1200 mg Myrtol Standardized were included. Progression-free survival (PFS) and overall survival (OS) were calculated, and carcinoembryonic antigen (CEA) trends were compared pretreatment and post-treatment in terms of percentage change.
Results:
Thirteen patients with extensive, recurrent disease (median peritoneal carcinomatosis index of 36) were included between 2017 and 2020. The median age was 63 years (interquartile range: 55 to 67) and 7 (54%) were male. A total of 85% had undergone prior cytoreductive surgery while 15% underwent cytoreductive surgery >2 times. 54% had received multiple cycles of systemic chemotherapy before starting Celecoxib-Myrtol. After a median follow-up of 8 months, median PFS and OS were 16 months (interquartile range: 5 to 17) and 27 months, respectively. Nine (69.2%) showed improvement in CEA values 3 months after treatment compared with 3-month pretreatment CEA trends. None had adverse events attributable to Celecoxib-Myrtol.
Conclusions:
Our feasibility study suggests that a regimen of Celecoxib-Myrtol is well tolerated and may prolong PFS and OS in patients with recurrent AMNs with peritoneal spread.
Insights
A combination of Celecoxib and Myrtol shows promise for treating unresectable appendiceal mucinous neoplasms (AMNs) with peritoneal spread. This novel regimen appears well-tolerated and may extend progression-free and overall survival in patients with recurrent AMNs.
Area of Science:
- Oncology
- Gastroenterology
- Pharmacology
Background:
- Unresectable appendiceal mucinous neoplasms (AMNs) with extensive peritoneal dissemination present significant challenges due to limited treatment options.
- These conditions lead to substantial patient morbidity.
Purpose of the Study:
- To evaluate a novel combination therapy of Celecoxib and Myrtol for treating unresectable AMNs with peritoneal spread.
- To assess the feasibility, tolerability, and potential survival benefits of this treatment regimen.
Main Methods:
- A cohort of 13 patients with recurrent AMNs and extensive peritoneal disease were treated with daily Celecoxib (200 mg) and Myrtol Standardized (1200 mg).
- Progression-free survival (PFS) and overall survival (OS) were calculated.
- Carcinoembryonic antigen (CEA) trends were compared pre- and post-treatment.
Main Results:
- The study included patients with a median peritoneal carcinomatosis index of 36, with most having prior surgeries and chemotherapy.
- After a median follow-up of 8 months, the median PFS was 16 months and median OS was 27 months.
- 69.2% of patients showed improved CEA values at 3 months, and no adverse events were attributed to the Celecoxib-Myrtol regimen.
Conclusions:
- The Celecoxib-Myrtol regimen is well-tolerated in patients with recurrent AMNs and peritoneal spread.
- This combination therapy may offer a potential benefit in prolonging PFS and OS for this patient population.
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