Although substantial clinical, epidemiological [28-33]
and pre-clinical data [34-44] points to a possible biological
role for NSAIDs, and in particular Aspirin, in influencing
the progression of colorectal cancer - to date no
clinical trial of Aspirin in the adjuvant setting has been
undertaken. Two large randomized studies exploring
cox-2 inhibitors, the EORTC PETACC and the VICTOR
trial had been undertaken, but were suspended prematurely,
due to concerns of cardiovascular toxicity. More
recently a new study by the CALGB exploring celecoxib
in Stage 3 colon cancer has been initiated in US. Nevertheless,
concerns still remain regarding cardiovascular
toxicity in prolonged use. Aspirin by contrast is a nonselective
cox inhibitor and is cardio-protective - and one
of the most widely used drugs with a long history of
use. If aspirin is indeed found to be beneficial, because
it is cheap and easy to administer, it may have a larger
impact for many patients in Asia and globally.