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J Gastroenterol 2009; 44[Suppl XIX]:7781 DOI 10.1007/s00535-008-2286-2
Chemoprevention of colorectal cancer in Japan: a brief introduction to current clinical trials
HIDEKI ISHIKAWA
1, TOMIYO NAKAMURA
1, ATSUKO KAWANO
2, NOBUHISA GONDO
3, and TOSHIYUKI SAKAI
1
1 Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, 3-2-17 Imahashi, Chuo-ku,
Osaka 541-0042, Japan
2 Division of Preventive and Social Medicine, Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan
3 Department of Surgery, Clinical Genetics, Hyogo College of Medicine, Hyogo, Japan
The rapidly increasing incidence of colorectal cancer in Japan poses a great challenge to researchers to develop preventive strategies against this disease. Thus far, several clinical trials for this purpose have been planned in Japanese subjects; some have been completed and documented while others are still ongoing. Also, the Ministry of Health, Labour and Welfare of Japan recognizes the signicance of cancer prevention studies, especially against colorectal cancer, including it as one of the pillars in the Third Research Project on General Strategies against Cancer and funding several large-scale projects. Among them are two chemoprevention studies currently being performed: in patients with previous sporadic colorectal tumors (J-CAPP study) and in patients with familial adenomatous polyposis (J-FAPP study II). Both are double-blind randomized controlled trials with low-dose aspirin (100 mg/day), which is generally considered to be safe for long-term use. This article outlines relevant past clinical data and gives a brief introduction to these two studies.
Key words: colorectal cancer, chemoprevention, aspirin, clinical trial
Introduction
Gastric cancer used to be the most common type of cancer in Japanese. Its position is, however, rapidly being replaced by colorectal cancer. According to the 2003 statistics, colorectal cancer has become the leading cause of death in overall cancer mortality in Japanese women. With this background, studies on colorectal cancer prevention are now being performed actively in Japan. Among other strategies, cancer prevention by
drugs, i.e., chemoprevention, is expected to have great potential for clinical application.
Candidate substances and target populations
Candidate substances expected to prevent colorectal cancer are shown in Table 1.
Based on recent genetic and epigenetic analyses of colorectal cancer,1,2 many substances are expected to be effective and have been examined. In particular, nonsteroidal antiinammatory drugs (NSAIDs) have attracted attention and have been studied...