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Patients with colon cancer whose tumors expressed HLA class I antigen demonstrated improved survival when they received aspirin for at least 2 weeks after their diagnosis, according to results of a cohort study.
The analysis included 999 patients, 18.2% (n=182) of whom received a prescription for aspirin for at least 14 days after their colon cancer diagnosis. The median duration of aspirin prescriptions was 30 days, and the mean number of prescriptions was 12 (range, 1-220).
Of 936 evaluable patients, 643 (66.8%) had tumors that expressed HLA class I antigen, whereas 320 (33.2%) did not. Aspirin use was comparable between patients whose tumors did and did not express HLA class I antigen (19% vs. 18%).
Among patients whose tumors expressed HLA class I antigen, aspirin use was associated with improved OS (RR=0.53; 95% CI, 0.38-0.74). However, aspirin users whose tumors did not express HLA class I antigen did not demonstrate a survival benefit (RR=1.03; 95% CI, 0.66-1.61).
Aspirin use conferred similar OS benefits among patients whose tumors had strong prostaglandin endoperoxide synthase 2 (PTGS2) expression (RR=0.68; 95% CI, 0.48-0.97) and those with weak PTGS2 expression (RR=0.59; 95% CI, 0.38-0.97).
Researchers observed a significant association between OS and aspirin use post-diagnosis among patients with wild-type PIK3CA tumors (RR=0.55; 95% CI, 0.40-0.75); however, researchers observed no association between OS and aspirin use among patients with PIK3CA-mutated tumors (RR=0.73; 95% CI, 0.33-1.63).
The findings suggest aspirin’s benefits in this setting must be weighed with the potential risks, Alfred I. Neugut, MD, PhD, of the department of medicine at the New York Presbyterian Hospital and at Columbia University Medical Center, wrote in an invited commentary.
“While aspirin has significant data demonstrating its benefits as a chemopreventive agent for colon cancer, its adverse effects (gastrointestinal tract bleeding, intracranial hemorrhage, gastritis) outweigh its benefits in the prevention setting (eg, giving aspirin to 2,000 average-risk adults might prevent one colorectal cancer at the expense of multiple cases of gastrointestinal tract bleeding [or] stroke),” Neugut wrote. “However, in the setting of patients with stage III colon cancer, who have significant risks for mortality, the risks of a daily aspirin seem minor relative to the putative gains in mortality.”