Effect of Celecoxib vs Placebo as Adjuvant Therapy on Disease-Free Survival Among Patients With Breast Cancer: The REACT Randomized Clinical Trial.

Abstract

Importance\nPatients with breast cancer remain at risk of relapse after adjuvant therapy. Celecoxib has shown antitumor effects in preclinical models of human breast cancer, but clinical evidence is lacking.\n\n\nObjective\nTo evaluate the role of celecoxib as an addition to conventional therapy for women with ERBB2 (formerly HER2)-negative primary breast cancer.\n\n\nDesign, Setting, and Participants\nThe Randomized European Celecoxib Trial (REACT) was a phase 3, randomized, double-blind study conducted in 160 centers across the UK and Germany testing 2 years of adjuvant celecoxib vs placebo among 2639 patients recruited between January 19, 2007, and November 1, 2012, with follow-up 10 years after treatment completion. Eligible patients had completely resected breast cancer with local and systemic therapy according to local practice. Patients with ERBB2-positive or node-negative and T1, grade 1 tumors were not eligible. Randomization was in a 2:1 ratio between celecoxib or placebo. Statistical analysis was performed from May 5, 2019, to March 5, 2020.\n\n\nInterventions\nPatients received celecoxib, 400 mg, or placebo once daily for 2 years.\n\n\nMain Outcomes and Measures\nThe primary end point was disease-free survival (DFS), analyzed in the intention-to-treat population using Cox proportional hazards regression and log-rank analysis. Follow-up is complete.\n\n\nResults\nA total of 2639 patients (median age, 55.2 years [range, 26.8-86.0 years]) were recruited; 1763 received celecoxib, and 876 received placebo. Most patients tumors (1930 [73%]) were estrogen receptor positive or progesterone receptor positive and ERBB2 negative. A total of 1265 patients (48%) had node-positive disease, and 1111 (42%) had grade 3 tumors. At a median follow-up of 74.3 months (interquartile range, 61.4-93.6 years), DFS events had been reported for 487 patients (19%): 18% for those who received celecoxib (n\u2009=\u2009323; 5-year DFS rate\u2009=\u200984%) vs 19% for those who received placebo (n\u2009=\u2009164; 5-year DFS rate\u2009=\u200983%); the unadjusted hazard ratio was 0.97 (95% CI, 0.80-1.17; log-rank P\u2009=\u2009.75). Rates of toxic effects were low across both treatment groups, with no evidence of a difference.\n\n\nConclusions and Relevance\nIn this randomized clinical trial, patients showed no evidence of a DFS benefit for 2 years treatment with celecoxib compared with placebo as adjuvant treatment of ERBB2-negative breast cancer. Longer-term treatment or use of a higher dose of celecoxib may lead to a DFS benefit, but further studies would be required to test this possibility.\n\n\nTrial Registration\nClinicalTrials.gov Identifier: NCT02429427 and isrctn.org Identifier: ISRCTN48254013.