The cyclooxygenase-2 pathway as a target for treatment or prevention of cancer

Cyclooxygenase (COX)-2, an inducible enzyme involved in prostaglandin biosynthesis, has attracted considerable attention recently, due to its role in human cancer biology. Several studies have correlated an increase in the expression of COX-2 with a poor clinical outcome, while epidemiological studies demonstrate a reduced risk of cancer mortality in persons with long-term, chronic ingestion of non-steroidal anti-inflammatory drugs (NSAIDs). Originally, these observations were made in patients with colorectal cancer, and subsequent studies suggest a protective role of NSAIDs in other human cancers as well. With the development of COX-2 specific inhibitors, numerous laboratory and clinical studies are underway to help understand the role of COX-2 in cancer and the potential use of COX-2 selective inhibitors for cancer treatment or prevention. This review focuses on the physiological function of COX, and the clinical rationale for evaluating COX-2 selective inhibitors for use in oncology.