Agents that can delay adenoma development or growth
and progression to cancer could play a vital role in delaying
prophylactic colectomy and preventing polyposis in a
retained rectum or ileoanal pouch after colectomy (40).
Early randomized control trials have shown the efficacy of
the NSAID, sulindac, and the cyclooxygenase-2 (COX-2)
selective inhibitors, celecoxib and rofecoxib, in reducing the
mean size of colorectal polyps and the mean number of
colorectal polyps after 6 to 9 months of treatment in FAP
patients (41–43). Aspirin has also been investigated in the
Colorectal Adenoma/carcinoma Prevention Programme 1
(CAPP1) study, a randomized, placebo-controlled trial of
aspirin 600 mg/d and/or resistant starch 30 g/d in a 2-by-2
factorial design. Among 133 evaluable patients, aspirin
treatment resulted in a nonsignificant reduction in polyp
number (RR ¼ 0.77; 95% CI, 0.54–1.10) compared with
nonaspirin, and a significant reduction in polyp size among
patients treated with aspirin for more than 1 year (44). The
efficacy of lower doses of aspirin (100 mg/d) in FAP patients
is currently being explored in the Japan Familial Adenomatous
Polyposis Prevention II (J-FAPP II) trial.