Primary Chemoprevention of Familial Adenomatous Polyposis with Sulindac

Sulindac, a nonsteroidal antiinflammatory drug, can induce the regression of polyps in familial adenomatous polyposis, which is caused by a mutation in the adenomatous polyposis coli ( APC ) gene. This study investigated whether sulindac therapy could prevent the development of colonic polyps in young carriers of a pathogenic mutant APC gene who had no detectable adenomas. As compared with a placebo, sulindac had no influence on the number or size of new polyps. Familial adenomatous polyposis is an autosomal dominant syndrome caused by a germ-line mutation of the adenomatous polyposis coli ( APC ) gene located at chromosome 5q21. 1 – 4 The disorder is characterized by the development of hundreds of colorectal adenomas during adolescence. 5 Colorectal cancer will develop in nearly all affected persons by the sixth decade of life if prophylactic colectomy is not performed. 5 Regression of established adenomatous polyps in patients with familial adenomatous polyposis who received sulindac, a nonsteroidal antiinflammatory drug (NSAID), was described in case reports in 1983 6 and 1989. 7 We and others have confirmed this observation in randomized studies . . .