Aspirin and colorectal cancer: the promise of precision chemoprevention

Abstract

Aspirin (acetylsalicylic acid) has become one of the most commonly used drugs, given its role as an analgesic, antipyretic and agent for cardiovascular prophylaxis. Several decades of research have provided considerable evidence demonstrating its potential for the prevention of cancer, particularly colorectal cancer. Broader clinical recommendations for aspirin-based chemoprevention strategies have recently been established; however, given the known hazards of long-term aspirin use, larger-scale adoption of an aspirin chemoprevention strategy is likely to require improved identification of individuals for whom the protective benefits outweigh the harms. Such a precision medicine approach may emerge through further clarification of aspirin's mechanism of action.

Hypoxia and Inflammation in Cancer, Focus on HIF and NF-кB

“…Many well-known NSAIDs, such as aspirin and ibuprofen, can be used to this scope. In fact, at low doses, aspirin has been suggested to prevent some types of cancer, including colorectal cancer [185], whereas at high doses, aspirin can inhibit the kinase activity of IKK or interfere with the degradation of IκBα, blocking NF-κB activity. Alongside NSAIDs, antiinflammatory and anti-cancer activities have been recognised for a number of natural products, glucocorticoids, immunosuppressants, or inhibitors of other pathways, directly affecting the NF-κB induction or signalling cascade, the translocation of NF-κB to the nucleus, the DNA binding of the dimers or their interactions with the transcriptional machinery [3].…”

Cancer Prevention and Interception: A New Era for Chemopreventive Approaches

“…On the basis of the increasing attention and scientific developments in the prevention field in the precision medicine era (11,20,31), in Table 1 we summarize in a list potential "to do" items to stop cancer before it starts or, in second instance, before it becomes fatal, in a prevention or interception setting.…”

“…Drug repurposing has also been debated as an effective option. Existing drugs such as aspirin, and other NSAIDs, metformin, and tamoxifen have shown to reduce cancer risk in observational studies or clinical trials with relatively low-risk profiles (8)(9)(10)(11)(12)(13)(14)(15). Very recently, the U.S. preventive service task force found adequate evidence that aspirin reduces the incidence of colorectal cancer in adults after 10 years of use, recommending taking low-dose aspirin for the primary prevention of cardiovascular disease and colorectal cancer in adults ages 50 to 59 years who have a 10% or greater 10-year cardiovascular disease risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years (16).…”

To share or not to share, the dilemma is going to be solved

“…This goal can be achieved by making anonymous individual records of the conventional clinical trials. Linkage of clinical trials data to administrative database gave new insights in the search of strategies for cancer prevention [4]. However, the possibility of de-identifying trial participants in the Big Data era is challenging.…”