Observational studies have linked aspirin and selective cyclooxygenase-2 (COX-2) inhibitors to prevention of colorectal adenomas and colorectal cancer, and reduction in recurrence following resection or improved survival for patients with advanced or metastatic disease. There are plausible mechanistic hypotheses linking inhibition of prostaglandin synthesis, nuclear factor κB activation, and the transcription factor RUNX1 to the anticancer effects of aspirin and celecoxib. In addition, there is evidence from a meta-analysis across multiple studies of the potential effects in terms of enhanced response rates when COX-2 inhibition was added to standard chemotherapy in advanced colorectal cancer and other solid cancers. However, this improvement did not translate to an improvement in 1-year survival.
