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Aspirin use may improve survival after colorectal cancer diagnosis
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Patients who started taking aspirin after receiving a diagnosis of colorectal cancer demonstrated improved OS and cancer-specific survival, according to the results of retrospective cohort study conducted in Norway.
“Aspirin used in a secondary preventive setting to prevent recurrence of the disease, would have a different cost–benefit ratio and a very low cost,” Kjetil Taskén, MD, PhD, director of The Biotechnology Centre of Oslo and the Norwegian Centre for Molecular Medicine, as well as professor of medicine at University of Oslo, told HemOnc Today. “We hypothesized a potentially more robust effect, as our previous work indicates, that there is prostaglandin-mediated suppression of antitumor immunity in colorectal cancer that could be reversed by aspirin, and that this effect would only kick in after the immune system has been exposed to the cancer.”
Kjetil Taskén
Although use of aspirin as primary prevention in the general public is debated due to the risk for gastric and cerebral hemorrhages, its use as secondary prevention in patients already diagnosed with colorectal cancer may offer greater benefit, taking into account the availability and price of aspirin, according to the researchers.
Taskén and colleagues linked data from the Cancer Registry of Norway and the Norwegian Prescription Database to identify 23,162 patients (female, n = 11,486) who were diagnosed with colorectal cancer between 2004 and 2011.
Of the study population, 26.3% (n = 6,102; mean age, 74 years) were exposed to aspirin following diagnosis, defined as receipt of aspirin prescription for more than 6 months after cancer diagnosis.
Cancer-specific survival and OS served as the primary study endpoints.
Median follow-up was 3 years.
In the aspirin cohort, 32.9% (n = 2,071) of patients died, 19% (n = 1,158) of whom died of colorectal cancer. By comparison, 42.3% (n = 7,218) of patients who were not exposed to aspirin postdiagnosis died, 31.5% (n = 5,735) of whom died of colorectal cancer.
Results of multivariable analyses showed aspirin exposure was associated with improved cancer-specific survival (HR = 0.85; 95% CI, 0.79-0.92) and OS (HR = 0.95, 95% CI, 0.9-1.01).
Further, researchers analyzed data by subdividing patients into three groups: those who had no aspirin exposure (reference, n = 17,060), those who had aspirin exposure after diagnosis only (n = 1,711), and those who were exposed before and after diagnosis (n = 4,391).
Data showed patients who used aspirin pre- and postdiagnosis experienced additional improvements in cancer-specific survival (HR = 0.77; 95% CI, 0.71-0.84) and OS (HR = 0.86; 95% CI, 0.81-0.92).
Additional supplementary analyses showed the greatest benefits of aspirin exposure among patients with poorly differentiated (HR = 0.83; 95% CI, 0.71-0.98) and moderately differentiated (HR = 0.84; 95% CI, 0.77-0.91) tumors, as well as among patients with stage II disease (HR = 0.71; 95% CI, 0.6-0.83).
When researchers evaluated outcomes based on tumor location, they found patients with tumors in the transverse and left colon experienced no significant improvement with aspirin, whereas patients with tumors in the rectum (HR = 0.79; 95% CI, 0.69-9) and right-sided tumors (HR = 0.88; 95% CI, 0.77-0.99) demonstrated improved cancer-specific survival.
Researchers noted the nonrandomized retrospective nature of the study may have impacted findings.
"The data show a strong and independent association of aspirin use yielding a 15% to 24% improvement in survival, but do not say that aspirin use is the cause," Taskén told HemOnc Today. "We had thought that the data on use of aspirin before diagnosis would come out differently. We thought that if a patient was on aspirin before developing cancer and still got cancer, he or she would be insensitive or less sensitive to continued administration of aspirin. However, the data shows the opposite: patients who do get colorectal cancer while on aspirin get less aggressive cancer." – by Nick Andrews
For more information:
Kjetil Taskén , MD, PhD, can be reached at kjetil.tasken@ncmm.uio.no.
Disclos ure: Taskén reports honoraria from and a consultant/advisory role with Pfizer, a board of directors role with PCI Biotech ASA, and stock or other ownership in Lauras Immuno AS and Spermatech AS. He also has given expert testimony for Gilead Sciences and is the inventor of patents and patent applications in areas of immune regulation and cardioprotection. The other researchers report no relevant financial disclosures.
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