Chemoprevention of colorectal cancer in ulcerative colitis: digging deep in current evidence.
Patients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). Surveillance colonoscopy is currently recommended for patients with long-standing extensive colitis for reducing CRC risk. Chemoprevention is an attractive complementary strategy. Areas covered: Inflammation is a major determinant of CRC risk and is potentially modifiable. Reducing inflammation is supposed to reduce CRC risk. Several medications have been evaluated in this setting: 5-ASA, thiopurines, anti-TNFα agents and ursodeoxycholic acid (UCDA) in patients with associated primary sclerosing cholangitis (PSC). This review offers a critical evaluation of current evidence of the potential chemopreventive effect of such medications. Expert commentary: No randomized controlled trials have been performed and the available evidence come from observational studies. Although biological plausibility supports a chemopreventive role of the aforementioned agents, the overall evidence of efficacy is weak because of several methodological limitations of the studies. Indirect epidemiological evidence, biologic plausibility and results of meta-analyses reasonably support a potential chemopreventive effect of 5-ASA. Available evidence does not support a specific chemopreventive effect of purine analogues and anti-TNFα medications, despite their efficacy in the management of inflammatory bowel disease. Data addressing UDCA and folate supplementation are inconclusive. Limited data are available for statins.
a Gastroenterology Unit , Rho Hospital, ASST Rhodense , Garbagnate Milanese , Italy.
Cristina
C
Bezzio
b IBD Unit , San Filippo Neri Hospital , Rome , Italy.
Stefano
S
Festa
a Gastroenterology Unit , Rho Hospital, ASST Rhodense , Garbagnate Milanese , Italy.
Simone
S
Saibeni
b IBD Unit , San Filippo Neri Hospital , Rome , Italy.
Claudio
C
Papi
D000818:Animals; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016588:Anticarcinogenic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D012307:Risk Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D016588:Anticarcinogenic Agents; D005765:Gastrointestinal Agents
Colorectal cancer; anti-TNF alpha; chemoprevention; folic acid; mesalazine; statins; thiopurines; ulcerative colitis; ursodeoxycholic acid