In this review, we discuss the available experimental evidences supporting the chemopreventive efficacy of nonsteroidal antiinflammatory drugs (NSAIDs) on colorectal cancer and the biological basis for their possible role as anticancer agents. Although the comprehension of the mechanisms underlying the effects of these drugs on colon cancer cells is incomplete, research efforts in identifying the biochemical pathway by which NSAIDs exert their chemopreventive effect have provided a rationale for the potential use of NSAIDs alone or in combination with conventional and experimental anticancer agents in the treatment of colorectal cancer. In this paper, we review three main issues: (i) the role of COX-2 in colon cancer; (ii) the common death pathways between NSAIDs and anticancer drugs; and (iii) the biological basis for the combination therapy with COX-2 selective inhibitors and new selective inhibitors of growth factor signal transduction pathways.
ROLE OF COX-2 IN COLON CANCERColorectal cancer is the third most common cancer in the world, and the second most common cause of cancer-related death. Despite the development of new strategies of aggressive surgical and adjuvant therapy, little progress has been made in the successful management of advanced disease; therefore, much hope is currently placed on chemoprevention.A large body of evidence from epidemiological studies and clinical trials in patients with the hereditary colon cancer syndrome, familial adenomatous polyposis coli (FAP) indicates that aspirin and related drugs, known as nonsteroidal antiinflammatory drugs (NSAIDs), which share the property of inhibiting the cyclooxygenase (COX) enzyme, hinder the development of colon cancer and perhaps other cancers as well.COX is the rate-limiting enzyme for the synthesis of eicosanoids, such as prostaglandins, from arachidonic acid. Two COX isoforms have been identified: the constitutively expressed COX-1 and the inducible COX-2. COX-1 is a housekeeping gene and has an important role in protecting the gastroduodenal mucosa. The COX-2 gene, an immediate-early response gene, is rapidly induced in response to tumour promoters, cytokines, and growth factors Di Popolo et al, 2000). NSAIDs may achieve different degrees of inhibition of COX-1 and COX-2 and can be grouped into selective and nonselective inhibitors of COX-2.The development of COX-2-specific inhibitors, like celecoxib and rofecoxib, drugs that maintain their anti-inflammatory properties while preserving the biosynthesis of protective prostaglandins, further raised interest in this field. A large body of research was therefore performed to clarify the relative involvement of the two COX isoforms in colorectal carcinogenesis and the role of COX-2-selective inhibitors as chemopreventive agents.COX-2, but not COX-1, expression was found to be increased in colorectal cancer (Eberhart et al, 1994): approximately 50% of adenomas and 80 -85% of adenocarcinomas showed increased expression of COX-2. This observation was later confirmed by other investigators. Mo...