Most Read Articles
Dr Margaret Shi, 18 May 2020

A blood test is shown to be feasible and safe for early detection of multiple cancers in women with no current or known history of cancer, enabling early treatment with curative intent in a subset of individuals.

Christina Lau, 20 Apr 2020

Hippocampal avoidance during whole-brain radiotherapy (HA-WBRT), together with memantine, better preserves cognitive function vs WBRT plus memantine in patients with brain metastases, without compromising survival, a multi-institutional phase III trial has shown.

Natalia Reoutova, 20 May 2020

Cancer patients infected with coronavirus disease 2019 (COVID-19) appear to be at higher risk of severe outcomes, including death, but cancer type and treatment serve as better predictors, according to recent research presented at the American Association for Cancer Research (AACR) 2020 Virtual Annual Meeting I.

At the time of writing, COVID-19 has spread to more than 200 countries and territories, affecting an estimated 4.5 million people and killing over 300,000. Cancer, on the other hand, is newly diagnosed in 18 million people and takes the lives of 10 million every year.

“We have invited physician scientists who are at the epicentre of the COVID-19 pandemic, taking care of patients with cancer. They gathered prospective information to understand the effects of COVID-19 on patients with cancer, are testing new treatments, and are making this knowledge available to the global research community, so we can all benefit from their experience,” said Professor Antoni Ribas from UCLA Medical Center, Los Angeles, California, US, chairperson of the COVID-19 and cancer plenary session of the meeting.

Natalia Reoutova, 28 May 2020

Fasting-mimicking diet (FMD) cycles in combination with endocrine therapy (ET) cause metabolic changes in hormone receptor (HR)-positive breast cancer patients analogous to those observed in animal models, where they are associated with anticancer activity.

Aspirin protective against digestive cancers?

Audrey Abella
28 Apr 2020

Regular* aspirin use may have a favourable effect on digestive** cancers, a comprehensive meta-analysis has shown.

“There are ~175,000 deaths from bowel cancer predicted for 2020 in the EU, of which ~100,000 will be in people aged 50–74 years. If … regular aspirin use increases from 25–50 percent in this age group, this would mean that 5,000–7,000 deaths from bowel cancer and 12,000–18,000 new cases could be avoided if further studies show that aspirin does indeed [reduce] cancer risk,” explained senior author Dr Carlo La Vecchia from the University of Milan School of Medicine in Milan, Italy.

“Corresponding figures would be ~3,000 deaths each for oesophageal, stomach, and pancreatic cancer, and 2,000 deaths from [liver] cancer … Given the unfavourable prognoses for these cancers, the number of new cases would be only slightly greater … The findings … may have implications for the prevention of these highly lethal diseases,” he continued.

Pooled data from 113 studies (n=156,000 cases) revealed an inverse association between regular aspirin use and the risks of colorectal, squamous cell oesophageal, oesophagus/gastric cardia, stomach, hepatobiliary tract, and pancreatic cancers (relative risks [RRs], 0.73, 0.67, 0.61, 0.64, 0.62, and 0.78, respectively). [Ann Oncol 2020;doi:10.1016/j.annonc.2020.02.012]

“The associations are somewhat stronger in case-control than in cohort and nested case-control studies and are characterized by some between-study heterogeneity. The risk estimates are consistent across sex, geographical areas, and other selected covariates,” said the researchers.

 

Colorectal cancer

A linear dose-risk relation was seen between colorectal cancer (CRC) and aspirin use (RRs, 0.87–0.90, 0.64, and 0.50 for 75–100, 325, and 500 mg/day). These translate to a 10- and 35-percent CRC risk reduction with the respective low- and regular-dose, while high-dose aspirin cut the risk by half.

“However, the estimate for high-dose aspirin was based on a few studies and should be interpreted cautiously,” noted co-author Dr Cristina Bosetti from the Mario Negri Institute for Pharmacologic Research in Milan, Italy.

In terms of duration of aspirin use, the RRs for CRC dropped by 10 years (RR, 0.71). While the risk levels off for longer aspirin use, this is challenging to interpret given the paucity of data evaluating long-term aspirin use, noted the researchers.

 

Other digestive cancers

Linear drops in RR were also seen between a 10-year duration of aspirin use and risk of squamous cell oesophageal, stomach, and pancreatic cancers (RRs, 0.77, 0.65, and 0.56, respectively).

“[S]ince aspirin may cause gastrointestinal bleeding … part of the inverse association [could be] due to the avoidance of aspirin use in patients with early symptoms of oesophageal or stomach cancer,” said the researchers.

 

Chemopreventive role

The findings imply that the chemopreventive effect of aspirin tends to increase with longer duration of use, and with increasing dose for CRC, noted the researchers. From a biologic standpoint, this effect has been attributed to cyclooxygenase (COX) inhibition. “COX-2 isoform is abnormally expressed in many cancer cell lines and is implicated in the process of carcinogenesis, tumour growth, apoptosis, and angiogenesis.” [J Am Coll Cardiol 2016;68:967-976; J Natl Cancer Inst 1998;90:1529-1536; J Natl Cancer Inst 1998;90:1609-1620]

However, La Vecchia cautioned against taking aspirin for cancer prevention. “[This] should only be done in consultation with a doctor who can account [for] individual risk factors.”

While the findings do not confirm a link between aspirin use and head/neck cancers (HNCs), the variable characteristics and aetiological factors of different HNCs should be taken into context. Additional studies are warranted to elucidate the role of aspirin in this setting, they said.

It should also be noted that the bulk of the data is mostly observational hence the potential for bias. Inaccuracies in patients’ accounts may have factored in, and most studies lacked data on other medications that could have influenced the findings. The results should thus be validated by related ongoing trials. [Trials 2017;18:50; J Am Coll Cardiol 2015;66:74-85]

 

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Most Read Articles
Dr Margaret Shi, 18 May 2020

A blood test is shown to be feasible and safe for early detection of multiple cancers in women with no current or known history of cancer, enabling early treatment with curative intent in a subset of individuals.

Christina Lau, 20 Apr 2020

Hippocampal avoidance during whole-brain radiotherapy (HA-WBRT), together with memantine, better preserves cognitive function vs WBRT plus memantine in patients with brain metastases, without compromising survival, a multi-institutional phase III trial has shown.

Natalia Reoutova, 20 May 2020

Cancer patients infected with coronavirus disease 2019 (COVID-19) appear to be at higher risk of severe outcomes, including death, but cancer type and treatment serve as better predictors, according to recent research presented at the American Association for Cancer Research (AACR) 2020 Virtual Annual Meeting I.

At the time of writing, COVID-19 has spread to more than 200 countries and territories, affecting an estimated 4.5 million people and killing over 300,000. Cancer, on the other hand, is newly diagnosed in 18 million people and takes the lives of 10 million every year.

“We have invited physician scientists who are at the epicentre of the COVID-19 pandemic, taking care of patients with cancer. They gathered prospective information to understand the effects of COVID-19 on patients with cancer, are testing new treatments, and are making this knowledge available to the global research community, so we can all benefit from their experience,” said Professor Antoni Ribas from UCLA Medical Center, Los Angeles, California, US, chairperson of the COVID-19 and cancer plenary session of the meeting.

Natalia Reoutova, 28 May 2020

Fasting-mimicking diet (FMD) cycles in combination with endocrine therapy (ET) cause metabolic changes in hormone receptor (HR)-positive breast cancer patients analogous to those observed in animal models, where they are associated with anticancer activity.