Chemoprevention of colorectal cancer by non-steroidal anti-inflammatory drugs

Aim: To critically analyse the role of NSAIDs in colorectal cancer. Methods : Update of the chemoprotective effect of NSAIDs on colorectal cancer. Resu lts and Conclusion: Over the past 20 years exciting developments in clinica l and basic research have opened up the possibility of NSAID-induced colore ctal cancer chemoprevention. In particular, disclosure of the multistep gen etic pathway of colorectal carcinogenesis and recognition of the impact of the COX-2 gene on this process have been of utmost importance. These findin gs have led to the possibility of colorectal cancer prevention by the admin istration of agents such as NSAIDs. Although it is accepted that these agen ts are potent inhibitors of colorectal carcinogenesis, their side effects i n long-term use are of concern to clinicians dealing with colorectal cancer prevention. Moreover, neither the dose nor the duration of the medication, nor the most ideal compound with respect to protective effects against col orectal cancer, has been defined. Recently, selective COX-2 inhibitors have been developed which may show additional benefit compared to the classical NSAIDs. However, their efficacy and safety profiles need to be established firmly before large-scale use in colorectal cancer prevention can be consi dered. Based on the exciting developments it is anticipated that a more pre cise understanding of the molecular details of colorectal carcinogenesis wi ll finally lead to the optimal chemopreventive regimen.