March 06, 2017
3 min read
Save

NSAIDs increase mortality risk from type 1 endometrial cancer

Over-the-counter NSAIDs increased cancer-specific mortality by 66% among women with type 1 endometrial cancer, according to study results published in Journal of the National Cancer Institute.

“There is increasing evidence that chronic inflammation is involved in endometrial cancer progression, and data suggest that inhibition of inflammation through NSAID use plays a role,” Theodore M. Brasky, PhD, research assistant professor at The Ohio State University — James Cancer Hospital, said in a press release. “This study identifies a clear association that merits additional research to help us fully understand the biologic mechanisms behind this phenomenon.”

Theodore M. Brasky

Brasky and colleagues pooled data from the NRG Oncology/Gynecology Oncology Group 210 Study. The analysis included 4,374 women with endometrial cancer who completed presurgical questionnaires on NSAID use before cancer diagnosis, as well as the associated risk for mortality and recurrence after diagnosis.

Women diagnosed with type 1 endometrial cancer who reported regular NSAID use demonstrated a 66% increased risk for cancer-related death than women who reported no NSAID use.

Researchers observed statistically significant associations among women who reported both past NSAID use and use at diagnosis. However, the association was particularly significant among women who reported NSAID use for more than 10 years prior to cancer diagnosis.

HemOnc Today spoke with Brasky about the findings, as well as the potential explanation for the inverse association between NSAID use and endometrial cancer outcomes.

Question: What prompted you and your colleagues to conduct this study?

Answer: There has been significant interest in NSAIDs in terms of how they may affect prognosis after a cancer diagnosis, specifically in terms of improving survival. The best example is in colorectal cancer. We know use of aspirin reduces the risk for developing polyps and advanced polyps, but it also reduces the risk for colorectal cancer. Additionally, upon colorectal cancer diagnosis, use of NSAIDs has been shown to improve survival.

PAGE BREAK

Q: What clinical implications do your findings have for clinical practice?

A: The short answer is none. The long answer is, this is one of a small handful of studies to examine these questions. Our study is the largest. The problem is that the science is based upon replication of findings, and although our results are provocative and slightly disconcerting, these results do not necessarily reflect a causal relationship. We need additional studies to determine this. Without replication, it would be difficult to have an implication for practice. Long story short, I would not want the results of a single study to be interpreted as a need for change in policy. Nevertheless, it is notable that our findings are specific. The 66% increased risk for cancer-specific mortality among these patients was restricted to type 1 endometrial cancers. These cancers are common and are of very specific histologies as opposed to the less common and typically more aggressive type 2 endometrial cancers.

Q: Did the results surprise you?

A: We were pretty surprised. Most, if not all, biological evidence suggests the use of NSAIDs will — among other things — reduce inflammation. Reducing inflammation is critically important for reducing the risk for cancer, and to improve prognosis once diagnosis has been made. Inflammation itself is involved in a number of biological pathways that can promote tumor development and metastases. Inhibiting this process by the use of anti-inflammatory drugs is thought to be a good thing, and these drugs have been shown to do this in colorectal cancer. Unfortunately, we did not see this for the patients with endometrial cancer included in our study.

Q: What is the potential explanation for the inverse association between NSAID use and endometrial cancer outcomes?

A: There is not enough evidence to suggest a clear reason. Some data suggest the use of aspirin and other NSAIDs may affect certain cancer pathways, but these studies were conducted in healthy women. We do not have evidence to suggest this is happening in women with endometrial cancer.

Q: What might future research entail on this topic?

A: We are interested in looking at how NSAIDs affect the inflammatory process inside the uterus. If we can look at this effect in patients with cancer, this would be among our first steps.

Q: Is there anything else that you feel is important to mention?

A: It is important to understand that cardiovascular disease is the number one cause of death among women with endometrial cancer. Because many patients regularly use aspirin to reduce their risk for dying of cardiovascular disease, it is important that patients understand the results of this study do not imply that they should stop taking these medications. If patients are taking aspirin or NSAIDs regularly and have concerns, they need to consult their oncologists. – by Jennifer Southall

Reference:

Brasky TM, et al. J Natl Cancer Inst. 2017;doi:10.1093/jnci/djw251.

For more information:

Theodore M. Brasky, PhD, can be reached at theodore.brasky@osumc.edu.

Disclosure: Brasky reports no relevant financial disclosures.