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AI plus celecoxib more than doubles odds of clinical response in ER-positive breast cancerAdding celecoxib to hormone therapy improves early breast cancer response

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Key Takeaway
Note that AI plus celecoxib significantly improves calliper-based clinical response but does not improve survival outcomes.

This Phase III randomized trial enrolled 269 postmenopausal women with ER-positive resectable breast cancer and tumors >= 2cm. Patients were randomized to receive either an aromatase inhibitor (AI) plus celecoxib (400mg bid) or an AI plus placebo.

The primary endpoint was clinical response measured by callipers at 16 weeks. The addition of celecoxib to the AI regimen resulted in a significantly higher objective clinical response rate compared to the placebo group, with results of 72.9% versus 55.6% (Odds ratio = 2.3; 95% CI 1.3-3.8, P=0.003).

Secondary outcomes included ultrasound-determined response at 16 weeks, progression free survival, and overall survival. Ultrasound-determined response was not significantly enhanced in the celecoxib group (48.7% vs 41.2%, P=0.34). Progression free survival and overall survival remained similar between both treatment groups.

Short-term use of celecoxib at 400mg bd for 16 weeks was reported as safe with no excess cardiotoxicity observed. A limitation of the study included a reduced sample size of 269 due to slow accrual from an original plan of 1000 patients. While calliper-based clinical response improved, there is no evidence of improved surgical or long-term outcomes from AI plus COX-2 inhibition.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in the management of ER-positive breast cancer by evaluating the role of COX-2 inhibition. While previous coverage noted that neoadjuvant chemotherapy with angiogenesis inhibitors improves pathological complete response rates specifically in triple-negative breast cancer, this study focuses on ER-positive cases and shows that while celecoxib improves calliper-based clinical response, it does not translate to improved ultrasound-determined response or survival outcomes.

For women dealing with estrogen receptor-positive breast cancer, finding a treatment that works quickly is vital. A recent Phase III trial looked at what happens when patients take an aromatase inhibitor—a common hormone therapy—alongside the drug celecoxib for 16 weeks.

The study involved 269 postmenopausal women with tumors at least 2 centimeters in size. The results showed that adding celecoxib significantly improved the clinical response rate, jumping from 55.6% in the placebo group to 72.9% in the group receiving both medications. This suggests a stronger initial reaction to the treatment.

While the early clinical response was better with celecoxib, other measures told a different story. Ultrasound-determined responses and long-term outcomes like progression-free survival or overall survival did not show significant differences between the two groups. The study also confirmed that using celecoxib for 16 weeks was safe and did not cause extra heart issues.

What this means for you:
Adding celecoxib to hormone therapy improves early clinical response in some breast cancer patients, but doesn't change long-term survival.

Common questions

Does adding celecoxib improve the treatment's effectiveness?

The study found that adding 400mg of celecoxib twice a day to hormone therapy significantly improved the clinical response rate at 16 weeks, reaching 72.9% compared to 55.6% with a placebo. However, this did not result in different outcomes for ultrasound-determined response or long-term survival.

Is it safe to take celecoxib with hormone therapy?

The trial reported that using 400mg of celecoxib twice a day for 16 weeks was safe. The researchers specifically noted that no extra heart problems were observed in the group taking the combination of aromatase inhibitors and celecoxib.

Does this treatment help women live longer?

While the initial clinical response was better with the addition of celecoxib, the study did not find a significant difference in progression-free survival or overall survival between the two groups. You should talk to your doctor about how these results apply to your specific situation.

Study Details

Study typeRct
Sample sizen = 269
EvidenceLevel 2
PublishedJul 2026
View Original Abstract ↓
Background The NEO-EXCEL trial hypothesised that aromatase inhibitor (AI)-activity as neoadjuvant endocrine therapy for early-stage breast cancer in postmenopausal women may be enhanced in combination with cyclooxygenase-2 (COX-2) inhibition. Methods NEO-EXCEL was a phase III, placebo-controlled, randomised trial in postmenopausal women with oestrogen receptor (ER)-positive resectable breast cancer with tumours [≥]2cm. Women were randomised (1:1:1:1): exemestane (25mg od) plus celecoxib (400mg bid), exemestane (25mg od) plus placebo (bid), letrozole (2.5mg od) plus celecoxib (400mg bid), or letrozole (2.5mg od) plus placebo (bid). Primary endpoint was clinical response (complete/partial) measured by callipers at 16 weeks; a standard assessment method at the time of trial inception. Sixteen-week ultrasound-determined response was the main secondary outcome to verify the calliper-based primary. Analysis was intention-to-treat. Results Due to slow accrual the trial design was redesigned from a definitive 2x2, 1000 patient trial to one randomising 269 patients between 20-Nov-2007 and 29-Apr-2014; 34.9% were human epithelial growth factor receptor 2-positive. AI+celecoxib produced a significantly greater objective clinical response than AI+placebo (72.9% vs 55.6%, P=0.003), which remained after adjustment for AI type and stratification factors (odds ratio = 2.3; 95% CI 1.3-3.8, P=0.003). Ultrasound-determined response was however not significantly enhanced (48.7% [AI+celecoxib] vs 41.2% [AI+placebo], P=0.34). Progression free survival and overall survival remained similar (median follow-up = 5.1 years [range 0.1-7.1]). Conclusions NEO-EXCEL is the first completed, phase III double-blind, placebo-controlled trial testing the addition of celecoxib to AI as neoadjuvant endocrine therapy in early breast cancer. Clinical response showed significant improvement but there was no significant ultrasound-determined response improvement nor any surgical or long-term outcome evidence of AI+COX-2 inhibition improving treatment outcomes for ER+ early resectable postmenopausal breast cancers. Use of short-term celecoxib at 400mg bd for 16 weeks was safe with no excess cardiotoxicity observed.
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