Cyclooxygenase-2 (COX-2) enzyme inhibitors as potential enhancers of tumor radioresponse.

Cyclooxygenase-2 (COX-2) is an enzyme induced by a variety of factors including tumor promoters, cytokines, growth factors and hypoxia. It is involved in the metabolic conversion of arachidonic acid to prostanoids, primarily in inflammatory states and tumors. In normal tissues, prostanoids are synthesized by COX-1, and they exert numerous homeostatic physiologic functions. COX-2 overexpression is linked to carcinogenesis, maintenance of progressive tumor growth and facilitation of metastatic spread. COX-2 and its products may act as protectors against cell damage by ionizing radiation. I describe findings showing that inhibition of COX-2 or prostanoids by selective COX-2 inhibitors or commonly used nonsteroidal antiinflammatory drugs (NSAIDs) has antitumor activity and may improve tumor response to radiation without significantly affecting normal tissue radioresponse. COX-2 inhibitors and radiation interact in multiple complex ways, with the enzyme inhibitor directly or indirectly augmenting tumor cell destruction by radiation. COX-2 represents a potential molecular target for improvement of cancer radiotherapy.