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Open Access Study protocol

Eicosapentaenoic acid (EPA) efficacy for colorectal aberrant crypt foci (ACF): a double-blind randomized controlled trial

Takuma Higurashi1, Kunihiro Hosono1, Hiroki Endo1, Hirokazu Takahashi1, Hiroshi Iida1, Takashi Uchiyama2, Akiko Ezuka3, Shiori Uchiyama3, Eiji Yamada1, Hidenori Ohkubo1, Eiji Sakai1, Shin Maeda1, Satoshi Morita4, Yutaka Natsumeda5, Hajime Nagase3 and Atsushi Nakajima1*

Author Affiliations

1 Division of Gastroenterology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan

2 Department of Gastroenterology, Chigasaki Municipal Hospital, Kanagawa, Japan

3 Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama, Japan

4 Department of Biostatistics and Epidemiology, Yokohama City University School of Medicine, Yokohama, Japan

5 Department of molecular pharmacology and neurobiology, Yokohama City University School of Medicine, Yokohama, Japan

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BMC Cancer 2012, 12:413  doi:10.1186/1471-2407-12-413

Published: 19 September 2012

Abstract

Background

Colorectal cancer (CRC) is one of the most commonly occurring neoplasms and a leading cause of cancer death worldwide, and new preventive strategies are needed to lower the burden of this disease. Eicosapentaenoic acid (EPA), the omega-3 polyunsaturated fatty acid that is widely used in the treatment of hyperlipidemia and prevention of cardiovascular disease, has recently been suggested to have a suppressive effect on tumorigenesis and cancer cell growth. In CRC chemoprevention trials, in general, the incidence of polyps or of the cancer itself is set as the study endpoint. Although the incidence rate of CRC would be the most reliable endpoint, use of this endpoint would be unsuitable for chemoprevention trials, because of the relatively low occurrence rate of CRC in the general population and the long-term observation period that it would necessitate. Moreover, there is an ethical problem in conducting long-term trials to determine whether a test drug might be effective or harmful. Aberrant crypt foci (ACF), defined as lesions containing crypts that are larger in diameter and stain more darkly with methylene blue than normal crypts, are considered as a reliable surrogate biomarker of CRC. Thus, we devised a prospective randomized controlled trial as a preliminary study prior to a CRC chemoprevention trial to evaluate the chemopreventive effect of EPA against colorectal ACF formation and the safety of this drug, in patients scheduled for polypectomy.

Methods

This study is a multicenter, double-blind, placebo-controlled, randomized controlled trial to be conducted in patients with both colorectal ACF and colorectal polyps scheduled for polypectomy. Eligible patients shall be recruited for the study and the number of ACF in the rectum counted at the baseline colonoscopy. Then, the participants shall be allocated randomly to either one of two groups, the EPA group and the placebo group. Patients in the EPA group shall receive oral 900-mg EPA capsules thrice daily (total daily dose, 2.7 g per day), and those in the placebo group shall receive oral placebo capsules thrice daily. After one month’s treatment with EPA/placebo, colonoscopic examination and polypectomy will be performed to evaluate the formation of ACF, and the cell-proliferative activity and cell-apoptotic activity in normal colorectal mucosa and colorectal polyps.

Discussion

This is the first study proposed to explore the effect of EPA against colorectal ACF formation in humans.

This trial has been registered in the University hospital Medical Information Network (UMIN) Clinical Trials Registry as UMIN000008172.