Effect of low-dose aspirin use on survival of patients with gastrointestinal malignancies

Frouws, M.A. et al. (2017) British Journal of Cancer. 116, pp. 405-413

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Background: Previous studies suggested a relationship between aspirin use and mortality reduction. The mechanism for the effect of aspirin on cancer outcomes remains unclear. The aim of this study was to evaluate aspirin use and survival in patients with gastrointestinal tract cancer.

 

Conclusions: Post-diagnosis use of aspirin in patients with gastrointestinal tract malignancies is associated with increased survival in cancers with different sites of origin and biology. This adds weight to the hypothesis that the anti-cancer effects of aspirin are not tumour-site specific and may be modulated through the tumour micro-environment.

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NSAIDs and Endometrial Carcinoma Mortality and Recurrence

Brasky, T.M. et al. (2017) JNCI: Journal of National Cancer Institute. 109(3) djw251

B0010228 Diclofenac, anti-inflammatory and pain relief drug, LM
Image source: Maurice Mikkers – Wellcome Images // CC BY-NC-ND 4.0

Image shows cross polarised light micrograph of diclofenac.

Background: Recent data suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reductions in endometrial cancer risk, yet very few have examined whether their use is related to prognosis among endometrial cancer patients.

 

Conclusions: In this study, use of NSAIDs was associated with increased endometrial carcinoma–specific mortality, especially in patients with type I tumors. Barring a clear biologic mechanism by which NSAIDs would increase the risk of cause-specific mortality, cautious interpretation is warranted.

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Aspirin ‘may double life expectancy of cancer patients’

Study of 14,000 people with cancer in gastrointestinal tract finds regular users of drug twice as likely to be alive after four years

Over view from the Guardian via Aspirin ‘may double life expectancy of cancer patients’ | Society | The Guardian.

A daily dose of aspirin can double the life expectancy of patients with cancers affecting the gastrointestinal tract, according to a study. It was already known that that frequent use of aspirin can prevent bowel cancer, but the most recent study also suggests that men and women with a range of cancers who take the anti-inflammatory painkiller experience a significant survival benefit compared with those who do not. The study of 14,000 cancer patients in the Netherlands found that regular users of aspirin were twice as likely to still be alive after a four-year period as those who did not take the cheap drug. According to the report’s authors, the impact of aspirin on survival was seen after adjusting for factors such as gender, age, stage of cancer, treatments, and other medical conditions that could have influenced death rates.

Conference abstract via Searchable Programme for ECC2015.

Background:

Epidemiological evidence shows a dual role in the relation between aspirin and cancer; both preventative and therapeutic effects are suggested. The biological mechanism of aspirin is still part of debate. Stratification in specific localizations in the entire gastro intestinal tract could lead to new insights towards the effect of aspirin as a therapeutic agent. Previous research focused mainly on the effect in colorectal cancer. The objective of this retrospective cohort study is to determine the association of aspirin use solely post diagnosis and survival for all distinct gastro intestinal malignancies.

Material and Methods:

All patients with cancer of the gastro intestinal tract diagnosed between 1998 and 2011 were selected from the population-based Eindhoven Cancer Registry and linked to drug dispensing data from the PHARMO Database Network. The association between aspirin use after diagnosis and overall survival was analyzed using Cox regression models with time-varying exposure. Aspirin use was recorded in periods of use and no use per patient. Relative survival was estimated, defined as the ratio between the observed survival in the cohort and expected survival in the general population.

Results:

In total, 13.715 patients were diagnosed with a gastro intestinal malignancy, 4.187 (30.5%) used aspirin prediagnosis, 1.143 were solely postdiagnosis users (8.3%) and 8.385 (61.1%) were non-users. For this analyses, solely postdiagnosis users and nonusers were selected(n=9.528). The largest groups were colon (4081; 42.8%), rectal (2370; 24.9%) and esophageal (972; 10.2%) cancer patients. Median follow-up time for all patients was 26.5 months (range 0–180.7) with a five year overall survival of 56%. In total, 5.440 events were reported. Overall and relative survival for aspirin users will be presented at the congress.

Conclusion:

Aspirin use initiated after diagnosis of gastro intestinal malignancies is associated with higher overall and relative survival rates. In January 2015 the Aspirin trial started in the Netherlands. This phase III multicenter, placebo-controlled, randomised trial will study the effects of aspirin on recurrence and survival in elderly patients with stage II and III colon cancer.

Aspirin’s anti-cancer effects depend on a person’s genetic make-up

A person’s genetic make-up might determine whether they could benefit from taking aspirin to prevent bowel cancer, according to a US study. The findings also suggest that the drug could even increase cancer risk in a minority of people – although experts cautioned that more research was needed to confirm this.

The team combined the results of several previous studies on aspirin and other similar drugs – collectively called non-steroidal anti-inflammatory drugs, or NSAIDs – comprising more than 8,600 people who went on to develop bowel cancer, and a similar number who remained healthy.

They then analysed participants’ DNA records, and looked at whether certain genetic variants, known as single-nucleotide polymorphisms, were more or less common in each group.

As well as confirming the overall benefits of aspirin in preventing the disease, they found that nearly one in 10 study participants (nine per cent) who had a particular genetic variation received no benefit from the drug.

And a further four per cent – one in 25 – who carried one of two other DNA variants appeared to have an increased likelihood of going on to develop bowel  cancer after taking aspirin.

Link to the research: Nan H, Hutter CM, Lin Y, et al. Association of Aspirin and NSAID Use With Risk of Colorectal Cancer According to Genetic Variants. JAMA. 2015;313(11):1133-1142. doi:10.1001/jama.2015.1815.