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A methodologic analysis of chemoprevention and cancer prevention strategies for gastrointestinal cancer

Nature Clinical Practice Gastroenterology & Hepatology volume 3, pages 101–111 (2006)Cite this article

Abstract

Gastroenterology lags behind other specialties such as cardiology in the quality of its evidence base for clinical practice. One area where this is particularly evident is in cancer prevention, despite developments in chemoprevention strategies for high-risk patients. For chemoprevention strategies to be successful, we need appropriate clinical networks and translational science infrastructures, model chemoprevention agents and multiple, large, flexible and randomized clinical trials. Translational science must also be embedded into large-scale, long-term, randomized clinical trials that have hard endpoints, so that irrefutable evidence of the longevity of treatment efficacy can be gathered. We also need to be able to identify an individual's cancer risk using valid global patient populations, so that medical benefits can be applied to all, regardless of ethnicity, sex, economic status, age and comorbidities. The future success of gastrointestinal chemoprevention relies on fostering a closer link between basic pharmaceutical research and clinical applications, in a 'bench to bedside and back' manner. In this review we systematically assess the evidence for various cancer prevention strategies, especially chemoprevention, and highlight the obstacles to further exploitation of this knowledge base.

Key Points

  • The incidence of gastroesophageal cancer is increasing and the prognosis is not improving, especially for esophageal adenocarcinoma

  • Cancer prevention through screening and surveillance is unproven and not cost effective

  • Chemoprevention is unproven but shows promise, especially as several efficacious and tolerated agents are available to test

  • Bottlenecks to mass chemoprevention trials include undeveloped translational networks, rudimentary pharmacogenetics and conservative trial designs

  • The future holds promise for a combined therapy for chemoprevention and cardiac protection

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Figure 1: The bridges between clinician scientists and patient populations.

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Acknowledgements

We would like to thank Professor Doug Altman and Professor Adrian Harris of Cancer Research UK and Professor David Kerr as well as Dr Raghib Ali of Oxford University for their helpful comments and suggestions during the preparation of this manuscript. JA Jankowski receives funding from Cancer Research UK, the National Cancer Research Institute, UK, University of Oxford, UK and University Hospitals of Leicester, UK. ET Hawk receives funding from the National Cancer Institute, USA.

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford University, Oxford

    Janusz A Jankowski

  2. London Research Institute, Cancer Research UK, London, UK

    Janusz A Jankowski

  3. Leicester Royal Infirmary, Leicester, UK

    Janusz A Jankowski

  4. Section Director of Cancer Prevention at the Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA

    Ernest T Hawk

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  1. Janusz A Jankowski
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Correspondence to Janusz A Jankowski.

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Competing interests

JA Jankowski is supported in part by educational grants from several pharmaceutical companies and is funded by Cancer Research UK. He also holds the deputy chair of the NCRI translational science group.

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Jankowski, J., Hawk, E. A methodologic analysis of chemoprevention and cancer prevention strategies for gastrointestinal cancer. Nat Rev Gastroenterol Hepatol 3, 101–111 (2006). https://doi.org/10.1038/ncpgasthep0412

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  • DOI: https://doi.org/10.1038/ncpgasthep0412

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