- Diagnosis of phenotypic classical FAP with disease involvement of the duodenum and/or
1. Genotype: APC mutation (with or without family history) required
2. Classical FAP Phenotype: 100's to 1,000's of colorectal adenomatous polyps,
usually appearing in teenage years
- UGI endoscopy/LGI endoscopy (proctoscopy/colonoscopy) performed within 30 days of
- Patients with an intact colon/rectum, except for clinical polyposis, and prophylactic
surgery is being considered as a stratification site.
- Rectal/pouch polyposis as a stratification site as follows:
1. At least three years since colectomy with IRA/proctocolectomy with pouch, and
demonstrating polyposis as defined by Stage 1, 2, 3, of the proposed InSiGHT
2011 Staging System (Appendix B) and summarized as follows:
Stage 1: 10-25 polyps, all < 5 mm Stage 2: 10-25 polyps, at least one > 1 cm
Stage 3: >25 polyps amenable to complete removal, or any incompletely removed
sessile polyp, or any evidence of high grade dysplasia, even if completely
removed. [Note: For staging purposes only.]
2. For all subjects, any rectal/pouch polyps > 5 mm must be excised at "baseline".
- Duodenal polyposis as a stratification site; one or more of the following:
1. Current Spigelman Stage 3 or 4. (Refer to Appendix A for Modified Spigelman
Score and Classification table).
2. Prior surgical endoscopic intervention within the past six months for Spigelman
Stage 3 or 4 that may have been down staged to Spigelman 1 or 2.
- Hematopoietic Status (within 30 days prior to randomization):
1. No significant hematologic abnormalities
2. WBC at least 3,000/mm3
3. Platelet count at least 100,000/mm3
4. Hemoglobin at least 10.0 g/dL
5. No history of clinical coagulopathy
- Hepatic Status (within 30 days prior to randomization):
1. Bilirubin no greater than 1.5 times ULN
2. AST and ALT no greater than 1.5 times ULN
3. Alkaline phosphatase no greater than 1.5 times ULN
- Renal Status (within 30 days prior to randomization):
a) Creatinine no greater than 1.5 times ULN
a) No clinically significant hearing loss, defined in Section 6.2, number 9.
- If female, neither pregnant nor lactating.
- Negative pregnancy test if female of child-bearing potential. Fertile patients must
use effective contraception*.
- Absence of gross blood in stool; red blood on toilet paper only acceptable.
- No discrete gastric or duodenal ulcer greater than 5 mm within the past year except
Helicobacter pylori-related peptic ulcer disease treated with antibiotics.
- No invasive malignancy within the past 5 years except resected non-melanomatous skin
cancer, papillary thyroid cancer, or precancerous cervical dysplasia.
- No other significant medical or psychiatric problems that would preclude study
participation or interfere with capacity to give informed consent.
- Use of 81-100 mg daily aspirin or up to 700 mg aspirin not more than once a week are
- No concurrent warfarin, fluconazole, lithium, Pradaxa or other direct thrombin
inhibitors, Plavix, cyclosporine, other NSAIDs (such as ibuprofen, aspirin,
diflunisal), diuretics (furosemide and thiazides), DMSO, methotrexate, probenecid,
propoxyphene hydrochloride, Tylenol (acetaminophen) preparations containing aspirin
or cytotoxic chemotherapy drugs.
- Willingness to forego concurrent use of supplements containing omega-3 fatty acids,
corticosteroids, non-steroidal anti-inflammatory drugs or other FAP directed drug
- Able to provide informed consent and follow protocol requirements.
- Prior pelvic irradiation.
- Patients receiving oral corticosteroids within 30 days of enrollment.
- Treatment with other investigational agents in the prior 4 weeks.
- Use of other non-steroidal anti-inflammatory drugs (such as ibuprofen) exceeding 4
days per month, in the prior 6 weeks.
- Regular use of aspirin in excess of 700 mg per week.
- Treatment with other FAP directed drug therapy (including sulindac or celecoxib, fish
oil) within 12 weeks of study enrollment.
- Hypersensitivity to cyclooxygenase-2 inhibitors, sulfonamides, NSAIDs, or
salicylates; NSAID associated symptoms of gastritis.
- Patients must not have cardiovascular disease risk factors as defined below:
- Uncontrolled high blood pressure (systolic blood pressure > 150 mm Hg
- Unstable angina
- History of documented myocardial infarction or cerebrovascular accident
- New York Heart Association Class III or IV heart failure
- Known uncontrolled hyperlipidemia defined as LDL-C >= 190 mg/dL or triglycerides
>= 500 mg/dL
- Patients with significant hearing loss are not eligible for study participation
defined as hearing loss that affects everyday life and/or for which a hearing aid is
- Colon/rectum/pouch with high grade dysplasia or cancer on biopsy or a large polyp (>1
cm) not amenable to complete removal.
- Duodenal cancer on biopsy.
- Intra-abdominal desmoid disease, stage III or IV
- Inability to provide informed consent.
Minimum Eligible Age: 18 Years
Maximum Eligible Age: N/A
Eligible Gender: Both