Pharmacotherapy for inherited colorectal cancer

Importance of the field: An important recent consideration in the medical management of colorectal cancer risk has been the notion of primary prevention or 'chemoprevention' of adenomas. A number of promising agents, and even combinations of agents, have shown promise in clinical trials. This review is written in the interest of capturing the current state of chemoprevention in familial adenomatous polyposis (FAP). This will take a decidedly clinical perspective. Areas covered in this review: This review addresses mainly randomized clinical chemoprevention trials. A search using PubMed from 1980 to present was conducted. What the reader will gain: The reader should gain an appreciation of the role that chemoprevention clinical trials in FAP has had in establishing a basis for clinically oriented use of selected drugs, mainly sulindac and celecoxib, as adjuncts to surgical and endoscopic treatment. In addition, the reader will see how FAP trials can provide a foundation for similar trials in nonfamilial adenomas. Take-home message: As a proving ground for new, potential chemopreventive agents, trials in FAP involved short-term (3- to 12-month) administration of drug. Endpoints generally involved measures of adenoma regression in the rectal segment retained post-colectomy.