Resveratrol for cancer prevention: Current gaps and opportunities

The increasing incidence of cancer worldwide, coupled with spiralling treatment costs, presents a situation that is not sustainable for health care systems. Going forward, it is clear there must be a much greater emphasis on prevention strategies. Effective implementation of preventive therapies could have a profound impact on cancer incidence and mortality. Resveratrol (trans-3,5,40-trihydroxystilbene), a constituent of grapes, peanuts, certain berries and red wine, has received considerable attention as a potential agent that can prevent cancer. Hundreds of preclinical studies have attested to its preventive activity in a variety of in vitro and in vivo models across a spectrum of malignancies. The pharmacokinetics, metabolism and safety of resveratrol in humans is now well established through small scale studies, but to date, few clinical trials have attempted to evaluate its effects on endpoints relevant to cancer. This review describes how resveratrol fulfils the requirements of a cancer preventive therapy and highlights the gaps that still need addressing as part of its development. We focus on malignancies where clinical trials have already been conducted or there is a significant weight of evidence supporting the design of trials, namely skin, colorectal, breast and prostate. We also suggest routes to advancing resveratrol towards efficacy studies in high-risk populations; colorectal cancer stands out as having a sufficient body of data that support testing resveratrol in a phase II polyp prevention trial.