ECC 2015

Survival in all gastrointestinal cancers improved by aspirin post diagnosis

Ms Martine Frouws - Leiden University Medical Center, Leiden, The Netherlands

Now, there has been evidence that aspirin could hold back colorectal cancer but why were you interested in looking at it in all of the GI malignancies?

The first evidence points towards the effect in colorectal cancer but there is very little known about the etiology of the effect of aspirin on cancer. By doing this study we thought maybe we can get a better direction towards the etiology of the effect if we assess it gastrointestinal tract wide.

What do you think might be the etiology?

That’s an interesting question. This study is mainly to observe, we didn’t have any data to say something about the etiology but if we have the possibility in the future to investigate all this tumour tissue then we can assess all the different biomarkers of these patients and that way we can also offer tailored treatment with adjuvant aspirin.

Right. Well now you’ve looked at all the GI malignancies and the effect aspirin might be having, what have you discovered so far?

We’ve found that patients using aspirin after diagnosis of gastrointestinal malignancies live twice as long as patients not using aspirin after diagnosed with their gastrointestinal malignancy. For example, after five years we saw 75% of patients using aspirin were alive in their group versus 42% of patients not using aspirin.

Were there any particular GI malignancies that were more effective with aspirin or more easily prevented with aspirin?

The study is not about prevention but it’s adjuvant treatment with aspirin after patients are diagnosed. We saw that in all the distinct organs of the gastrointestinal tract only not for pancreatic cancer, that’s the only one.

And how many patients all together have your investigations looked at, then, over all of these malignancies?

Over 14,000 patients, about 14,000 patients sorry.

That’s evidence so far, is that enough, do you think, for doctors to begin to recommend patients who already have a diagnosis of a GI malignancy to take aspirin?

Unfortunately my answer has to be no to that because in this study it’s retrospective so we don’t have any information on, for example, the side effects when you give aspirin to patients with cancer. I think that’s very important to be investigated and that’s why randomised controlled trials to assess the effect of aspirin on cancer have to be done.

Now you are, in fact, now beginning a randomised study. What sort of dose of aspirin are you using and what are you doing in this study?

We give patients 100mg of aspirin after they are diagnosed with colon cancer and we assess overall survival at five years and then we randomise between aspirin and placebo for these patients.

How long are you going to need to study this for?

We think it will take about eight years before we have the results because patients have to use it for five years and then we assess overall survival. So before we have the results may unfortunately take a while.

Obviously these are provocative data, what do you suggest cancer professionals should be doing about these data right now?

At this moment it will only give us direction that aspirin has an effect on cancer but in the clinic or for the doctors, I don’t think at this moment they have to take any action.

So the recommendation is no action yet but watch this space.

Yes.