Clinical effects of NSAIDs and COXIBs in colon cancer prevention

Abstract

A large body of evidence from epidemiological, experimental and clinical studies have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors (COXIBs) have a chemopreventive effect on gastrointestinal cancers and, more specifically, in colorectal cancer (CRC). This chapter summarises scientific evidence derived from clinical studies assessing the role of NSAIDs and COXIBs in the prevention of both sporadic and hereditary CRC. Unfortunately, adverse side effects associated to both of them, mainly at gastrointestinal and cardiovascular level, make difficult their use for primary chemoprevention. Among NSAIDs, almost the unique agent with potential use as chemopreventive agent is aspirin at low dose since it has both no cardiovascular and low gastrointestinal risk. Therefore, currently, the use of nonaspirin NSAIDs (NA-NSAIDs) or COXIBs is restricted to hereditary colorectal cancer patients, to delay the progression of polyposis. In addition, the potential use of these drugs in established colorectal cancer is being tested in ongoing clinical trials. In the last years, different chemical modifications have been introduced in some conventional NSAIDs in an attempt to improve their potency and safety. Although some of these compounds have been evaluated in experimental studies with promising results, further studies are warranted before they can be prescribed in clinical setting to prevent CRC.