Innovative treatment for colon cancerBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7273.1397 (Published 02 December 2000) Cite this as: BMJ 2000;321:1397
- G A Chung Faye,
- D J Kerr
Despite advances in treatment for colon cancer, the five year survival has not significantly altered over the past decade. Survival could improve in several key areas:
Dietary modifications to reduce the incidence of colon cancer may be difficult to implement (dietary interventional studies have shown this to be the case for cardiovascular disease); the roles of screening, chemotherapy, and radiotherapy have been covered earlier in this series
Preventive measures—such as diet and chemoprevention with agents such as non-steroidal anti-inflammatory drugs
Screening strategies—such as faecal occult blood testing and flexible sigmoidoscopy
Optimisation of current chemotherapy and radiotherapy regimens and the development of more effective antineoplastic agents
New therapeutic approaches—such as immunotherapy and gene therapy.
This article will focus on prevention with non-steroidal anti-inflammatory drugs and on new strategies for treating colon cancer.
Non-steroidal anti-inflammatory drugs
Evidence strongly suggests a protective effect of non-steroidal anti-inflammatory drugs in colon cancer. Several cohort and case-control studies have consistently shown dose related reductions of colorectal cancer in regular users of these drugs. Furthermore, patients with familial adenomatous polyposis who took the non-steroidal anti-inflammatory sulindac had reductions in the number and size of their polyps. Gene knockout studies in mice suggest that inhibition of the cyclo-oxygenase type 2 pathway by non-steroidal anti-inflammatory drugs may be important in the mechanism of action.
The only randomised controlled trial examining the …