Clinical and laboratory-based research in cancer chemoprevention is expanding in an attempt to prevent or postpone the disease. Definitive, clinical, Phase III trials include the current studies of tamoxifen. But equally important are the mechanism of action studies which will furnish better methods of designing and testing chemo-preventive agents, and the identification of specific biomarkers of car-cinogenesis that can serve as surrogate endpoint markers.

Table 12.1 Mechanisms of tumour suppression and examples of cancer chemopreventive agents

Scavenging oxygen radicals

Inhibition of arachidonic acid metabolism

Polyphenols (curcumin, genistein), selenium, tocopherol (vitamin E) N-acetylcysteine, NSAIDs (sulindac, aspirin), polyphenols, tamoxifen

Modulation of signal transduction NSAIDs, retinoids, tamoxifen, genistein, curcumin Modulation of hormonal/growth NSAIDs, retinoids, curcumin, factor activity tamoxifen

Inhibition of oncogene activity Genistein, NSAIDs, monoterpenes

(D-limonene, perillyl alcohol) Inhibition of polyamine metabolism 2-Difluoromethylornithine, retinoids, tamoxifen

Induction of terminal differentiation Calcium, retinoids, vitamin D3 Induction of apoptosis Genistein,curcumin, retinoids, tamoxifen

NSAIDs = non-steroidal anti-inflammatory drugs

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