Chemoprevention of gastrointestinal cancer

Gastrointestinal cancer remains a significant public health threat in developed countries. Even with breathtaking gains in our understanding of the molecular underpinnings of the most common GI cancers, it is clear that the best hope in the foreseeable future lies in the chemoprevention of recurrent cancer and its associated precursors. Colon cancer is an ideal disease for the application of chemopreventive strategies. The molecular biology of colon cancer has been well studied and it is an excellent model for the development of chemopreventive interventions. This fact allows clinical investigators to utilize what is known about discrete biological phases of colon carcinogenesis to tailor clinical trial protocols that may attenuate a future risk for cancer. Among the agents currently in clinical trial testing are anti-oxidants, modulators of metabolism, and antiproliferatives. Current clinical trials have often incorporated the use of biomarkers as intermediate endpoints to assess the efficacy of particular preventives. The current status of ongoing colon cancer prevention trials suggests that this disease, in particular, may well be suited to chemopreventive approaches.