Clinical trials update: Tertiary prevention of colorectal cancer

Jason A Zell
Department of Medicine and Epidemiology, School of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92697, USA.
DOI: 10.4103/1477-3163.78271


Colorectal cancer (CRC) is a major cause of cancer incidence and mortality worldwide. However, the past two decades have brought major advances in CRC screening and therapeutics, including advances in surgery, radiation therapy, chemotherapy, and targeted biologic therapy. As a result, the incidence and mortality of CRC have declined and there are now an increasing number of CRC survivors. Upon completing their initial course of therapy, patients with CRC have a keen interest in adopting dietary and lifestyle activities in an attempt to reduce the risk of recurrent cancer. That particular moment in time has been eloquently referred to as the “teachable moment” for oncologists – a time when patients are receptive and willing to consider adopting lifestyle practices for the purposes of risk reduction.[1] Even after the initial course of therapy, CRC patients represent an important “high-risk group” to be targeted for preventive therapeutics via clinical trial enrollment. There are now observational data supporting the importance of dietary [2],[3] and lifestyle behaviors (such as physical activity) [4],[5] on survival after CRC diagnosis. However, data are lacking from large-scale clinical trials in support of concrete recommendations for preventing CRC recurrence in the survivorship setting. With the growing population of CRC survivors and advances in the understanding of several well-tolerated therapeutic agents, there has been renewed interest in developing strategies for CRC risk reduction among CRC patients. This is reflected in the current state of the United States National Cancer Institute (NCI)-supported cooperative group clinical trials system, where three large randomized, controlled clinical trials have emerged that will hopefully optimize our approach to risk reduction among CRC survivors over the next decade and beyond. Each of these trials involves a prolonged intervention period using oral medications to inhibit colorectal carcinogenesis through separate mechanisms, and they will be discussed here.Read More…