ACETYLSALICYLIC ACID:

AN ONCOPREVENTIVE

DRUG?

INTRODUCTION

We looked at aspirin in its positive role in cancer incidence, metastasis and mortality as primary

prevention, especially in colorectal cancer.

There are several theories outlining the mechanism of aspirin as an oncopreventive drug (Figure1).

Figure 1. The COX-2 Signaling Pathway and Associated Biologic Activities. From: Sanford D. Markowitz, Aspirin and Colon Cancer - Targeting Prevention? N Engl J Med 2007 356;21

FINDINGS • Colorectal cancer

incidence risk , especially with mutated PIK3CA and over expression of COX-23,4 (pooled odds ratio [OR]

0·62, 95% CI 0·58—0·67, p<0·0001, 17 studies)1,2

•Duration of aspirin use on the incidence of cancer and mortality

cancer mortality from > 5 years (562 vs. 664 deaths; odds ratio [OR] 0·85, 95% CI 0·7- 0·96, p=0·008; 34

trials, 69 224 participants (92 vs. 145; OR 0·63, 95% CI 0·49-0·82, p=0·0005)

cancer incidence from > 3 years (324 vs. 421 cases; OR 0·76, 95% CI 0·66-0·88, p=0·0003)5

• Reduction of adenocarcinoma cancers

death due to cancer in patients who developed adenocarcinoma, particularly in those without

metastasis at diagnosis5

aspirin reduced the overall risk of fatal adenocarcinoma in the trial populations6

overall 29% reduced risk of gastric cancer corresponding to aspirin use (RR  = 0.71, 95% CI 0.60-0.82)7

risk of ovarian cancer8

•Other cancers with reduction in rates: lung, pancreatic cancer and metastasis of multiple

cancers1

CONCLUSION

•Most of the studies looking into aspirin as an on copreventer have shown a decreased risk of

colorectal cancer incidence.

•Very important is the individualising decision for every patient while considering the net benefit of

aspirin prophylaxis.

•Further studies are required to determine the role of low- dose aspirin as an oncopreventer

Dr Lisa Gambhir

Formation spécifique en médecine générale, LU

lisa.gambhir@gmail.com

REFERENCES

1)Low-dose aspirin use and cancer characteristics: a

population-based cohort study. Jonsson F1, Yin L, Lundholm C,

et al. Br J Cancer. 2013 Oct 1;109(7):1921-5

2)Effects of regular aspirin on long-term cancer incidence and

metastasis: a systematic comparison of evidence from

observational studies versus randomised trials. Annemijn M

Algra, Prof Peter M RothwellThe Lancet Oncology, May 2012,

Volume 13, Issue 5, p. 518 - 527

3)Aspirin Use, Tumor PIK3CA Mutation, and Colorectal-Cancer

Survival. Xiaoyun Liao, Paul Lochhead, Reiko Nishihara et al. N

Engl J Med Oct 2012; 367:1596-1606

4)Aspirin and the Risk of Colorectal Cancer in Relation to the

Expression of COX-2. Andrew T. Chan, Shuji Ogino, and Charles

S. Fuchs. N Engl J Med May 2007; 356:2131-2142

5)Short-term effects of daily aspirin on cancer incidence,

mortality, and non-vascular death: analysis of the time course

of risks and benefits in 51 randomised controlled trials.

Rothwell PM, Price JF, Fowkes FG et al. The Lancet. April 2012;

379(9826):1602-12

6)Effect of daily aspirin on risk of cancer metastasis: a study

of incident cancers during randomised controlled trials.

Rothwell PM1, Wilson M, Price JF, Belch JF, Meade TW, Mehta Z.

The Lancet, April 2012, 379 (9826):1591-1601

7)Frequency-risk and duration-risk relationships between

aspirin use and gastric cancer: a systematic review and meta-

analysis. Ye X1, Fu J, Yang Y, Gao Y, Liu L, Chen S. PLoS One. Jul

30 2013;8(7):e71522

8)Aspirin, NSAIDs and acetaminophen use and risk of invasive

epithelial ovarian cancer: a pooled analysis in the Ovarian

Cancer Association Consortium. Trabert B1, Ness RB, Lo-

Ciganic WH et al. J Natl Cancer Inst., Feb 2014 ;106(2)

L Gambhir1, S Geeranavar2 1 Université du Luxembourg, FSGM

2 Langton Medical Group, Lichfield, UK

AIM

We reviewed the evidence of low-

dose aspirin as an oncopreventer,

determining the different types

of cancers.

METHOD

Summary from recent literature

regarding potential benefits

• reported associations

between aspirin use and the

outcome/risk of cancer,

metastasis and mortality

• duration of aspirin use and the

risk reduction of certain

cancers