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Erschienen in: Current Treatment Options in Gastroenterology 2/2021

22.02.2021 | Genetics in Gastroenterology Practice (BW Katona, Section Editor)

Management of Familial Adenomatous Polyposis

verfasst von: Gautam Mankaney, MD, Carole Macaron, MD, Carol A. Burke, MD

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 2/2021

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Abstract

Purpose of review

This paper reviews important aspects in the management of individuals with familial adenomatous polyposis (FAP).

Recent findings

Newly discovered germline pathogenic variants (PVs) beyond APC are a rare cause of adenomatous polyposis. The decreasing cost of multi-gene panel testing (MGPT) has broadened the use of commercial panels to enhance the genetic diagnosis of adenomatous polyposis in families where the causative germline PV in APC is not known. We elucidate emerging risks of cancer in FAP particularly gastric cancer and provide best practices to surveillance and cancer prevention in FAP, including dual therapy chemoprevention and trials utilizing novel mechanisms.

Summary

Genetic testing is indicated in individuals with ≥ 10 lifetime adenomas. FAP and MutYH-associated polyposis (MAP) will be the most common germline causes of colorectal adenomatous polyposis. In FAP, upper endoscopy is indicated for surveillance of gastric polyposis and gastric cancer in addition to duodenal polyposis. Novel agents for chemoprevention have been shown to be effective and considered for selective use in patients with FAP.
Literatur
1.
Zurück zum Zitat Nieuwenhuis MH, Vasen HF. Correlations between mutation site in APC and phenotype of familial adenomatous polyposis (FAP): a review of the literature. Crit Rev Oncol Hematol. 2007;61(2):153–61.PubMedCrossRef Nieuwenhuis MH, Vasen HF. Correlations between mutation site in APC and phenotype of familial adenomatous polyposis (FAP): a review of the literature. Crit Rev Oncol Hematol. 2007;61(2):153–61.PubMedCrossRef
2.
Zurück zum Zitat Ying L, Lin S, Baxter MD, et al. Novel APC promoter and exon 1B deletion and allelic silencing in three mutation-negative classic familial adenomatous polyposis families. Genome Med. 2015;7(1):42.CrossRef Ying L, Lin S, Baxter MD, et al. Novel APC promoter and exon 1B deletion and allelic silencing in three mutation-negative classic familial adenomatous polyposis families. Genome Med. 2015;7(1):42.CrossRef
3.
Zurück zum Zitat Li J, Woods SL, Healey S, Beesley J, Chen X, Lee JS, et al. Point mutations in exon 1B of APC reveal gastric adenocarcinoma and proximal polyposis of the stomach as a familial adenomatous polyposis variant. Am J Hum Genet. 2016;98:830–42.PubMedPubMedCentralCrossRef Li J, Woods SL, Healey S, Beesley J, Chen X, Lee JS, et al. Point mutations in exon 1B of APC reveal gastric adenocarcinoma and proximal polyposis of the stomach as a familial adenomatous polyposis variant. Am J Hum Genet. 2016;98:830–42.PubMedPubMedCentralCrossRef
4.
Zurück zum Zitat Jones S, Emmerson P, Maynard J, Best JM, Jordan S, Williams GT, et al. Biallelic germline mutations in MYH predispose to multiple colorectal adenoma and somatic G:C-->T:A mutations. Hum Mol Genet. 2002;11(23):2961–7.PubMedCrossRef Jones S, Emmerson P, Maynard J, Best JM, Jordan S, Williams GT, et al. Biallelic germline mutations in MYH predispose to multiple colorectal adenoma and somatic G:C-->T:A mutations. Hum Mol Genet. 2002;11(23):2961–7.PubMedCrossRef
5.
Zurück zum Zitat Vogt S, Jones N, Christian D. Expanded extracolonic tumor spectrum in MUTYH-associated polyposis. Gastroenterol. 2009;137:1976–85.CrossRef Vogt S, Jones N, Christian D. Expanded extracolonic tumor spectrum in MUTYH-associated polyposis. Gastroenterol. 2009;137:1976–85.CrossRef
6.
Zurück zum Zitat Win AK, Reece JC, Dowty JG, Buchanan DD, Clendenning M, Rosty C, et al. Risk of extracolonic cancers for people with biallelic and monoallelic mutations in MUTYH. Int J Cancer. 2016;139:1557–63.PubMedPubMedCentralCrossRef Win AK, Reece JC, Dowty JG, Buchanan DD, Clendenning M, Rosty C, et al. Risk of extracolonic cancers for people with biallelic and monoallelic mutations in MUTYH. Int J Cancer. 2016;139:1557–63.PubMedPubMedCentralCrossRef
7.
Zurück zum Zitat Grover S, Kastrinos F, Steyerberg EW, Cook EF, Dewanwala A, Burbidge LA, et al. Prevalence and phenotypes of APC and MUTYH mutations in patients with multiple colorectal adenomas. JAMA. 2012;308(5):485–92.PubMedPubMedCentralCrossRef Grover S, Kastrinos F, Steyerberg EW, Cook EF, Dewanwala A, Burbidge LA, et al. Prevalence and phenotypes of APC and MUTYH mutations in patients with multiple colorectal adenomas. JAMA. 2012;308(5):485–92.PubMedPubMedCentralCrossRef
9.
10.
Zurück zum Zitat Weren RD, Ligtenberg MJ, Kets CM, et al. A germline homozygous mutation in the base-excision repair gene NTHL1 causes adenomatous polyposis and colorectal cancer. Nat Genet. 2015;47(6):668–71.PubMedCrossRef Weren RD, Ligtenberg MJ, Kets CM, et al. A germline homozygous mutation in the base-excision repair gene NTHL1 causes adenomatous polyposis and colorectal cancer. Nat Genet. 2015;47(6):668–71.PubMedCrossRef
11.
Zurück zum Zitat Palles C, Cazier JB, Howarth KM, et al. Germline mutations affecting the proofreading domains of POLE and POLD1 predispose to colorectal adenomas and carcinomas. Nat Genet. 2013;45(2):136–44.PubMedCrossRef Palles C, Cazier JB, Howarth KM, et al. Germline mutations affecting the proofreading domains of POLE and POLD1 predispose to colorectal adenomas and carcinomas. Nat Genet. 2013;45(2):136–44.PubMedCrossRef
12.
Zurück zum Zitat Adam R, Spier I, Zhao B, Kloth M, Marquez J, Hinrichsen I, et al. Exome sequencing identifies biallelic MSH3 germline mutations as a recessive subtype of colorectal adenomatous polyposis. Am J Hum Genet. 2016;99(2):337–51.PubMedPubMedCentralCrossRef Adam R, Spier I, Zhao B, Kloth M, Marquez J, Hinrichsen I, et al. Exome sequencing identifies biallelic MSH3 germline mutations as a recessive subtype of colorectal adenomatous polyposis. Am J Hum Genet. 2016;99(2):337–51.PubMedPubMedCentralCrossRef
13.
Zurück zum Zitat Marvin ML, Mazzoni SM, Herron CM, et al. AXIN2-associated autosomal dominant ectodermal dysplasia and neoplastic syndrome. Am J Med Genet A. 2011;155A(4):898–902.PubMedCrossRef Marvin ML, Mazzoni SM, Herron CM, et al. AXIN2-associated autosomal dominant ectodermal dysplasia and neoplastic syndrome. Am J Med Genet A. 2011;155A(4):898–902.PubMedCrossRef
14.
Zurück zum Zitat McKenna DB, Van Den Akker J, Zhou AY, et al. Identification of a novel GREM1 duplication in a patient with multiple colon polyps. Familial Cancer. 2019;18(1):63–6.PubMedPubMedCentralCrossRef McKenna DB, Van Den Akker J, Zhou AY, et al. Identification of a novel GREM1 duplication in a patient with multiple colon polyps. Familial Cancer. 2019;18(1):63–6.PubMedPubMedCentralCrossRef
15.
Zurück zum Zitat Pearlman R, Frankel WL, Swanson B, Zhao W, Yilmaz A, Miller K, et al. Prevalence and spectrum of germline cancer susceptibility gene mutations among patients with early-onset colorectal cancer. JAMA Oncol. 2017;3(4):464–47.PubMedPubMedCentralCrossRef Pearlman R, Frankel WL, Swanson B, Zhao W, Yilmaz A, Miller K, et al. Prevalence and spectrum of germline cancer susceptibility gene mutations among patients with early-onset colorectal cancer. JAMA Oncol. 2017;3(4):464–47.PubMedPubMedCentralCrossRef
16.
Zurück zum Zitat •• Mankaney G, Cruise M, LaGuardia L, et al. Gastric cancer in FAP: a concerning rise in incidence. Familial Cancer. 2017;16(3):371–6 This study describes rising risk of gastric cancer in Western FAP.PubMedCrossRef •• Mankaney G, Cruise M, LaGuardia L, et al. Gastric cancer in FAP: a concerning rise in incidence. Familial Cancer. 2017;16(3):371–6 This study describes rising risk of gastric cancer in Western FAP.PubMedCrossRef
17.
Zurück zum Zitat Walton SJ, Frayling IM, Clark SK, Latchford A. Gastric tumors in FAP. Familial Cancer. 2017;16(3):363–9.PubMedCrossRef Walton SJ, Frayling IM, Clark SK, Latchford A. Gastric tumors in FAP. Familial Cancer. 2017;16(3):363–9.PubMedCrossRef
18.
Zurück zum Zitat Leone PJ, Mankaney G, Sarvapelli S, Abushamma S, Lopez R, Cruise M, et al. Endoscopic and histologic features associated with gastric cancer in FAP. Gastrointest Endosc. 2019;89(5):961–8.PubMedCrossRef Leone PJ, Mankaney G, Sarvapelli S, Abushamma S, Lopez R, Cruise M, et al. Endoscopic and histologic features associated with gastric cancer in FAP. Gastrointest Endosc. 2019;89(5):961–8.PubMedCrossRef
19.
Zurück zum Zitat Kannathu ND, Mankaney GN, Leone PJ, et al. Worrisome endoscopic feature in the stomach of patients with FAP: the proximal white mucosal patch. Gastrointest Endosc. 2018;88(3):569–70.CrossRef Kannathu ND, Mankaney GN, Leone PJ, et al. Worrisome endoscopic feature in the stomach of patients with FAP: the proximal white mucosal patch. Gastrointest Endosc. 2018;88(3):569–70.CrossRef
20.
Zurück zum Zitat •• Mankaney G, Cruise M, Sarvepalli S, et al. SPACE (Surveillance for Pathology Associated with Cancer on Endoscopy) criteria to identify high risk gastric polyps in familial adenomatous polyposis. Gastrointest Endosc. 2020;S0016–5107(20):34265–6 This study describes criteria to identify features associated with high-risk pathology in the stomach. •• Mankaney G, Cruise M, Sarvepalli S, et al. SPACE (Surveillance for Pathology Associated with Cancer on Endoscopy) criteria to identify high risk gastric polyps in familial adenomatous polyposis. Gastrointest Endosc. 2020;S0016–5107(20):34265–6 This study describes criteria to identify features associated with high-risk pathology in the stomach.
21.
Zurück zum Zitat Thiruvengadam SS, Lopez R, O’Malley M, et al. Spigelman stage IV duodenal polyposis does not precede most duodenal cancer cases in patients with familial adenomatous polyposis. Gastrointest Endosc. 2019;89(2):345–354.e2.PubMedCrossRef Thiruvengadam SS, Lopez R, O’Malley M, et al. Spigelman stage IV duodenal polyposis does not precede most duodenal cancer cases in patients with familial adenomatous polyposis. Gastrointest Endosc. 2019;89(2):345–354.e2.PubMedCrossRef
22.
Zurück zum Zitat Mehta N, Shah RS, Yoon JY, et al. Risks, benefits, and effects on management for biopsy of the papilla in patients with familial adenomatous polyposis. Clin Gastroenterol Hepatol. 2020;S1542-3565(20):30761–8. Mehta N, Shah RS, Yoon JY, et al. Risks, benefits, and effects on management for biopsy of the papilla in patients with familial adenomatous polyposis. Clin Gastroenterol Hepatol. 2020;S1542-3565(20):30761–8.
23.
Zurück zum Zitat Yoon JY, Mehta N, Burke CA. The prevalence and significance of jejunal and duodenal bulb polyposis after duodenectomy in familial adenomatous polyposis: retrospective cohort study. Ann Surg. 2019;Publish Ahead of Print. Yoon JY, Mehta N, Burke CA. The prevalence and significance of jejunal and duodenal bulb polyposis after duodenectomy in familial adenomatous polyposis: retrospective cohort study. Ann Surg. 2019;Publish Ahead of Print.
24.
Zurück zum Zitat Sarvepalli S, Burke CA, Monachese M, Leach BH, Laguardia L, O’Malley M, et al. Natural history of colonic polyposis in young patients with familial adenomatous polyposis. Gastrointest Endosc. 2018;88(4):726–33.PubMedCrossRef Sarvepalli S, Burke CA, Monachese M, Leach BH, Laguardia L, O’Malley M, et al. Natural history of colonic polyposis in young patients with familial adenomatous polyposis. Gastrointest Endosc. 2018;88(4):726–33.PubMedCrossRef
25.
Zurück zum Zitat Sarvepalli S, Burke CA, Monachese M, Lopez R, Leach BH, Laguardia L, et al. Web-based model for predicting time to surgery in young patients with familial adenomatous polyposis: an internally validated study. Am J Gastroenterol. 2018;113(12):1881–90.PubMedPubMedCentralCrossRef Sarvepalli S, Burke CA, Monachese M, Lopez R, Leach BH, Laguardia L, et al. Web-based model for predicting time to surgery in young patients with familial adenomatous polyposis: an internally validated study. Am J Gastroenterol. 2018;113(12):1881–90.PubMedPubMedCentralCrossRef
26.
Zurück zum Zitat Monachese M, Mankaney G, Lopez R, O’Malley M, Laguardia L, Kalady MF, et al. Outcome of thyroid ultrasound screening in FAP patients with a normal baseline exam. Familial Cancer. 2019;18(1):75–82.PubMedCrossRef Monachese M, Mankaney G, Lopez R, O’Malley M, Laguardia L, Kalady MF, et al. Outcome of thyroid ultrasound screening in FAP patients with a normal baseline exam. Familial Cancer. 2019;18(1):75–82.PubMedCrossRef
27.
Zurück zum Zitat Yang J, Gurudu SR, Koptiuch C, et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in familial adenomatous polyposis syndromes. Gastrointest Endosc. 2020;91(5):963–982.e2.PubMedCrossRef Yang J, Gurudu SR, Koptiuch C, et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in familial adenomatous polyposis syndromes. Gastrointest Endosc. 2020;91(5):963–982.e2.PubMedCrossRef
28.
Zurück zum Zitat Giardiello FM, Hamilton SR, Krush AJ, Piantadosi S, Hylind LM, Celano P, et al. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis. N Engl J Med. 1993;328(18):1313–6.PubMedCrossRef Giardiello FM, Hamilton SR, Krush AJ, Piantadosi S, Hylind LM, Celano P, et al. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis. N Engl J Med. 1993;328(18):1313–6.PubMedCrossRef
29.
Zurück zum Zitat Giardiello FM, Yang VW, Hylind LM, Krush AJ, Petersen GM, Trimbath JD, et al. Primary chemoprevention of familial adenomatous polyposis with sulindac. N Engl J Med. 2002;346(14):1054–9.PubMedPubMedCentralCrossRef Giardiello FM, Yang VW, Hylind LM, Krush AJ, Petersen GM, Trimbath JD, et al. Primary chemoprevention of familial adenomatous polyposis with sulindac. N Engl J Med. 2002;346(14):1054–9.PubMedPubMedCentralCrossRef
30.
Zurück zum Zitat Debinski HS, Trojan J, Nugent KP, Spigelman AD, Phillips RKS. Effect of sulindac on small polyps in familial adenomatous polyposis. Lancet. 1995;345(8953):855–6.PubMedCrossRef Debinski HS, Trojan J, Nugent KP, Spigelman AD, Phillips RKS. Effect of sulindac on small polyps in familial adenomatous polyposis. Lancet. 1995;345(8953):855–6.PubMedCrossRef
31.
Zurück zum Zitat Nugent KP, Farmer KC, Spigelman AD, et al. Randomized controlled trial of the effect of sulindac on duodenal and rectal polyposis and cell proliferation in patients with familial adenomatous polyposis. Br J Surg. 1993;80(12):1618–9.PubMedCrossRef Nugent KP, Farmer KC, Spigelman AD, et al. Randomized controlled trial of the effect of sulindac on duodenal and rectal polyposis and cell proliferation in patients with familial adenomatous polyposis. Br J Surg. 1993;80(12):1618–9.PubMedCrossRef
32.
Zurück zum Zitat Steinbach G, Lynch P, Philips RK, et al. The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis. N Engl J Med. 2000;342(26):1946–52.PubMedCrossRef Steinbach G, Lynch P, Philips RK, et al. The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis. N Engl J Med. 2000;342(26):1946–52.PubMedCrossRef
33.
Zurück zum Zitat Phillips RK, Wallace MH, Lynch PM, Hawk E, Gordon GB, Saunders BP, et al. A randomised, double blind, placebo controlled study of celecoxib, a selective cyclooxygenase 2 inhibitor, on duodenal polyposis in familial adenomatous polyposis. Gut. 2002;50(6):857–60.PubMedPubMedCentralCrossRef Phillips RK, Wallace MH, Lynch PM, Hawk E, Gordon GB, Saunders BP, et al. A randomised, double blind, placebo controlled study of celecoxib, a selective cyclooxygenase 2 inhibitor, on duodenal polyposis in familial adenomatous polyposis. Gut. 2002;50(6):857–60.PubMedPubMedCentralCrossRef
34.
Zurück zum Zitat Burke CA, Phillips R, Berger MF, Li C, Essex MN, Iorga D, et al. Children’s International Polyposis (CHIP) study: a randomized, double-blind, placebo-controlled study of celecoxib in children with familial adenomatous polyposis. Clin Exp Gastroenterol. 2017;10:177–85.PubMedPubMedCentralCrossRef Burke CA, Phillips R, Berger MF, Li C, Essex MN, Iorga D, et al. Children’s International Polyposis (CHIP) study: a randomized, double-blind, placebo-controlled study of celecoxib in children with familial adenomatous polyposis. Clin Exp Gastroenterol. 2017;10:177–85.PubMedPubMedCentralCrossRef
35.
Zurück zum Zitat Burn J, Bishop DT, Chapman PD, Elliott F, Bertario L, Dunlop MG, et al. A randomized placebo-controlled prevention trial of aspirin and/or resistant starch in young people with familial adenomatous polyposis. Cancer Prev Res. 2011;4(5):655–65.CrossRef Burn J, Bishop DT, Chapman PD, Elliott F, Bertario L, Dunlop MG, et al. A randomized placebo-controlled prevention trial of aspirin and/or resistant starch in young people with familial adenomatous polyposis. Cancer Prev Res. 2011;4(5):655–65.CrossRef
36.
Zurück zum Zitat Solomon SD, McMurray JJV, Pfeffer MA, et al. Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. N Engl J Med. 2005;352(11):1071–80.PubMedCrossRef Solomon SD, McMurray JJV, Pfeffer MA, et al. Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. N Engl J Med. 2005;352(11):1071–80.PubMedCrossRef
37.
Zurück zum Zitat West NJ, Clark SK, Phillips RK, et al. Eicosapentaenoic acid reduces rectal polyp number and size in familial adenomatous polyposis. Gut. 2010;59(7):918–25.PubMedCrossRef West NJ, Clark SK, Phillips RK, et al. Eicosapentaenoic acid reduces rectal polyp number and size in familial adenomatous polyposis. Gut. 2010;59(7):918–25.PubMedCrossRef
38.
Zurück zum Zitat Ishikawa H, Wakabayashi K, Suzuki S, Mutoh M, Hirata K, Nakamura T, et al. Preventive effects of low-dose aspirin on colorectal adenoma growth in patients with familial adenomatous polyposis: double-blind, randomized clinical trial. Cancer Med. 2013;2(1):50–6.PubMedPubMedCentralCrossRef Ishikawa H, Wakabayashi K, Suzuki S, Mutoh M, Hirata K, Nakamura T, et al. Preventive effects of low-dose aspirin on colorectal adenoma growth in patients with familial adenomatous polyposis: double-blind, randomized clinical trial. Cancer Med. 2013;2(1):50–6.PubMedPubMedCentralCrossRef
39.
Zurück zum Zitat Cruz-Correa M, Hylind LM, Hernandez-Marrero J, et al. Efficacy and safety of curcumin in treatment of intestinal adenomas in patients with familial adenomatous polyposis. Gastroenterol. 2018;155(3):668–73.CrossRef Cruz-Correa M, Hylind LM, Hernandez-Marrero J, et al. Efficacy and safety of curcumin in treatment of intestinal adenomas in patients with familial adenomatous polyposis. Gastroenterol. 2018;155(3):668–73.CrossRef
40.
Zurück zum Zitat Bussey HJ, DeCosse JJ, Deschner EE, et al. A randomized trial of ascorbic acid in polyposis coli. Cancer. 1982;50(7):1434–9.PubMedCrossRef Bussey HJ, DeCosse JJ, Deschner EE, et al. A randomized trial of ascorbic acid in polyposis coli. Cancer. 1982;50(7):1434–9.PubMedCrossRef
41.
Zurück zum Zitat DeCosse JJ, Miller HH, Lesser ML, et al. Effect of wheat fiber and vitamins C and E on rectal polyps in patients with familial adenomatous polyposis. J Natl Cancer Inst. 1989;81(17):1290–7.PubMedCrossRef DeCosse JJ, Miller HH, Lesser ML, et al. Effect of wheat fiber and vitamins C and E on rectal polyps in patients with familial adenomatous polyposis. J Natl Cancer Inst. 1989;81(17):1290–7.PubMedCrossRef
42.
Zurück zum Zitat Lynch PM, Burke CA, Phillips R, Morris JS, Slack R, Wang X, et al. An international randomised trial of celecoxib versus celecoxib plus difluoromethylornithine in patients with familial adenomatous polyposis. Gut. 2016;65(2):286–95.PubMedCrossRef Lynch PM, Burke CA, Phillips R, Morris JS, Slack R, Wang X, et al. An international randomised trial of celecoxib versus celecoxib plus difluoromethylornithine in patients with familial adenomatous polyposis. Gut. 2016;65(2):286–95.PubMedCrossRef
43.
Zurück zum Zitat Burke CA, Dekker E, Lynch P, Samadder NJ, Balaguer F, Hüneburg R, et al. Eflornithine plus sulindac for prevention of progression in familial adenomatous polyposis. N Engl J Med. 2020;383:1028–39.PubMedCrossRef Burke CA, Dekker E, Lynch P, Samadder NJ, Balaguer F, Hüneburg R, et al. Eflornithine plus sulindac for prevention of progression in familial adenomatous polyposis. N Engl J Med. 2020;383:1028–39.PubMedCrossRef
44.
Zurück zum Zitat •• Samadder NJ, Neklason DW, Boucher KM, et al. Effect of sulindac and erlotinib vs placebo on duodenal neoplasia in familial adenomatous polyposis: a randomized clinical trial. JAMA. 2016;315(12):1266–75 This study highlights the efficacy of combination therapy in the management of upper duodenal neoplasia in FAP.PubMedPubMedCentralCrossRef •• Samadder NJ, Neklason DW, Boucher KM, et al. Effect of sulindac and erlotinib vs placebo on duodenal neoplasia in familial adenomatous polyposis: a randomized clinical trial. JAMA. 2016;315(12):1266–75 This study highlights the efficacy of combination therapy in the management of upper duodenal neoplasia in FAP.PubMedPubMedCentralCrossRef
45.
Zurück zum Zitat Samadder NJ, Kuwada SK, Boucher KM, Byrne K, Kanth P, Samowitz W, et al. Association of sulindac and erlotinib vs placebo with colorectal neoplasia in familial adenomatous polyposis: secondary analysis of a randomized clinical trial. JAMA Oncol. 2018;4(5):671–7.PubMedPubMedCentralCrossRef Samadder NJ, Kuwada SK, Boucher KM, Byrne K, Kanth P, Samowitz W, et al. Association of sulindac and erlotinib vs placebo with colorectal neoplasia in familial adenomatous polyposis: secondary analysis of a randomized clinical trial. JAMA Oncol. 2018;4(5):671–7.PubMedPubMedCentralCrossRef
46.
Zurück zum Zitat Li H, Schut HA, Conran P, et al. Prevention by aspirin and its combination with alpha-difluoromethylornithine of azoxymethane-induced tumors, aberrant crypt foci and prostaglandin E2 levels in rat colon. Carcinogenesis. 1999;20:425–30.PubMedCrossRef Li H, Schut HA, Conran P, et al. Prevention by aspirin and its combination with alpha-difluoromethylornithine of azoxymethane-induced tumors, aberrant crypt foci and prostaglandin E2 levels in rat colon. Carcinogenesis. 1999;20:425–30.PubMedCrossRef
47.
Zurück zum Zitat Jacoby RF, Cole CE, Tutsch K, et al. Chemopreventive efficacy of combined piroxicam and difluoromethylornithine treatment of Apc mutant Min mouse adenomas, and selective toxicity against Apc mutant embryos. Cancer Res. 2000;60:1864–70.PubMed Jacoby RF, Cole CE, Tutsch K, et al. Chemopreventive efficacy of combined piroxicam and difluoromethylornithine treatment of Apc mutant Min mouse adenomas, and selective toxicity against Apc mutant embryos. Cancer Res. 2000;60:1864–70.PubMed
48.
Zurück zum Zitat Meyskens FL Jr, McLaren CE, Pelot D, et al. Difluoromethylornithineplus sulindac for the prevention of sporadic colorectal adenomas: a randomized placebo-controlled, double-blind trial. Cancer Prev Res. 2008;1(1):32–8.CrossRef Meyskens FL Jr, McLaren CE, Pelot D, et al. Difluoromethylornithineplus sulindac for the prevention of sporadic colorectal adenomas: a randomized placebo-controlled, double-blind trial. Cancer Prev Res. 2008;1(1):32–8.CrossRef
49.
Zurück zum Zitat Bohan PM, Mankaney G, Vreeland TJ, et al. Chemoprevention in familial adenomatous polyposis: past, present, and future. Familial Cancer. 2020;8:1–11. Bohan PM, Mankaney G, Vreeland TJ, et al. Chemoprevention in familial adenomatous polyposis: past, present, and future. Familial Cancer. 2020;8:1–11.
50.
Zurück zum Zitat Kariv R, Caspi M, Fliss-Isakov N, et al. Resorting the function of the colorectal cancer gatekeeper adenomatous polyposis coli. Int J Cancer. 2020;146(4):1064–74.PubMedCrossRef Kariv R, Caspi M, Fliss-Isakov N, et al. Resorting the function of the colorectal cancer gatekeeper adenomatous polyposis coli. Int J Cancer. 2020;146(4):1064–74.PubMedCrossRef
Metadaten
Titel
Management of Familial Adenomatous Polyposis
verfasst von
Gautam Mankaney, MD
Carole Macaron, MD
Carol A. Burke, MD
Publikationsdatum
22.02.2021
Verlag
Springer US
Erschienen in
Current Treatment Options in Gastroenterology / Ausgabe 2/2021
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI
https://doi.org/10.1007/s11938-020-00324-9

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