Impact of aspirin as secondary prevention in an unselected cohort of 25,644 patients with colorectal cancer: A population-based study.

Bains, Simer Jit; Mahic, Milada; Cvancarova, Milada; Yaqub, Sheraz; Dørum, Liv Marit; Bjørnbeth, Bjørn Atle; Møller, Bjørn; Brudvik, Kristoffer Watten; Taskén, Kjetil

doi:10.1200/jco.2015.33.15_suppl.3504

Cited by 6 publications

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“… CI: confidence interval; HR Hazard Ratio; HR: hazard ratio; RCT: randomised controlled trial. a Hazard ratios taken from Langley [ 20 ] b Randomisation was achieved by admitting patients to two different wards in which aspirin and placebo were given. …”

Section: Resultsmentioning

confidence: 99%

“…The sixteen reports of patients with colorectal cancer [ 8 , 19 – 33 ] give a pooled hazard ratio (HR) of 0.71 (95% CI 0.58, 0.87) for cause specific mortality (11 reports) and there is marked heterogeneity. Sensitivity analyses identified Bains [ 20 ] and when omitted there is reduced heterogeneity, and the HR is 0.76 (95% CI 0.66, 0.88). Three of these studies give data for the effect of aspirin in the proximal and the distal colon separately.…”

Section: Resultsmentioning

confidence: 99%

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Aspirin in the Treatment of Cancer: Reductions in Metastatic Spread and in Mortality: A Systematic Review and Meta-Analyses of Published Studies

et al. 2016

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BackgroundLow-dose aspirin has been shown to reduce the incidence of cancer, but its role in the treatment of cancer is uncertain.ObjectivesWe conducted a systematic search of the scientific literature on aspirin taken by patients following a diagnosis of cancer, together with appropriate meta-analyses.MethodsSearches were completed in Medline and Embase in December 2015 using a pre-defined search strategy. References and abstracts of all the selected papers were scanned and expert colleagues were contacted for additional studies. Two reviewers applied pre-determined eligibility criteria (cross-sectional, cohort and controlled studies, and aspirin taken after a diagnosis of cancer), assessed study quality and extracted data on cancer cause-specific deaths, overall mortality and incidence of metastases. Random effects meta-analyses and planned sub-group analyses were completed separately for observational and experimental studies. Heterogeneity and publication bias were assessed in sensitivity analyses and appropriate omissions made. Papers were examined for any reference to bleeding and authors of the papers were contacted and questioned.ResultsFive reports of randomised trials were identified, together with forty two observational studies: sixteen on colorectal cancer, ten on breast and ten on prostate cancer mortality. Pooling of eleven observational reports of the effect of aspirin on cause-specific mortality from colon cancer, after the omission of one report identified on the basis of sensitivity analyses, gave a hazard ratio (HR) of 0.76 (95% CI 0.66, 0.88) with reduced heterogeneity (P = 0.04). The cause specific mortality in five reports of patients with breast cancer showed significant heterogeneity (P<0.0005) but the omission of one outlying study reduced heterogeneity (P = 0.19) and led to an HR = 0.87 (95% CI 0.69, 1.09). Heterogeneity between nine studies of prostate cancer was significant, but again, the omission of one study led to acceptable homogeneity (P = 0.26) and an overall HR = 0.89 (95% CI 0.79–0.99). Six single studies of other cancers suggested reductions in cause specific mortality by aspirin, and in five the effect is statistically significant. There were no significant differences between the pooled HRs for the three main cancers and after the omission of three reports already identified in sensitivity analyses heterogeneity was removed and revealed an overall HR of 0.83 (95% CI 0.76–0.90). A mutation of PIK3CA was present in about 20% of patients, and appeared to explain most of the reduction in colon cancer mortality by aspirin. Data were not adequate to examine the importance of this or any other marker in the effect of aspirin in the other cancers. On bleeding attributable to aspirin two reports stated that there had been no side effect or bleeding attributable to aspirin. Authors on the other reports were written to and 21 replied stating that no data on bleeding were available.Conclusions and ImplicationsThe study highlights the need for randomised trials of aspirin treatment in ...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Aspirin in the Treatment of Cancer: Reductions in Metastatic Spread and in Mortality: A Systematic Review and Meta-Analyses of Published Studies

et al. 2016

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“…A meta-analysis of such studies showed that aspirin use resulted in significant reductions in the risk of developing cancer, most notably in colorectal (relative risk (RR) 0.73, 95% confidence-interval (CI) 0.67–0.79), gastric (RR 0.67, CI 0.54–0.83), adenocarcinoma of the oesophagus/cardia (RR 0.67, CI 0.54–0.83), squamous cell carcinoma of the oesophagus (RR 0.64, CI 0.52–0.78), breast (RR 0.90, CI 0.85–0.95), and prostate cancer (RR 0.90, CI 0.85–0.98) [2]. Observational studies have also shown improvements in survival with aspirin use after a diagnosis of breast [3], [4], [5], colorectal [6], [7], [8], [9], [10], [11], gastro-oesophageal [12], [13] and prostate cancer [14], [15], [16].…”

Section: Background and Introductionmentioning

confidence: 99%

ADD-ASPIRIN: A phase III, double-blind, placebo controlled, randomised trial assessing the effects of aspirin on disease recurrence and survival after primary therapy in common non-metastatic solid tumours

Coyle

Cafferty

Rowley

et al. 2016

Contemporary Clinical Trials

136

106

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BackgroundThere is a considerable body of pre-clinical, epidemiological and randomised data to support the hypothesis that aspirin has the potential to be an effective adjuvant cancer therapy.MethodsAdd-Aspirin is a phase III, multi-centre, double-blind, placebo-controlled randomised trial with four parallel cohorts. Patients who have undergone potentially curative treatment for breast (n = 3100), colorectal (n = 2600), gastro-oesophageal (n = 2100) or prostate cancer (n = 2120) are registered into four tumour specific cohorts. All cohorts recruit in the United Kingdom, with the breast and gastro-oesophageal cohort also recruiting in India. Eligible participants first undertake an active run-in period where 100 mg aspirin is taken daily for approximately eight weeks. Participants who are able to adhere and tolerate aspirin then undergo a double-blind randomisation and are allocated in a 1:1:1 ratio to either 100 mg aspirin, 300 mg aspirin or a matched placebo to be taken daily for at least five years. Those participants ≥ 75 years old are only randomised to 100 mg aspirin or placebo due to increased toxicity risk.ResultsThe primary outcome measures are invasive disease-free survival for the breast cohort, disease-free survival for the colorectal cohort, overall survival for the gastro-oesophageal cohort, and biochemical recurrence-free survival for the prostate cohort, with a co-primary outcome of overall survival across all cohorts. Secondary outcomes include adherence, toxicity including serious haemorrhage, cardiovascular events and some cohort specific measures.ConclusionsThe Add-Aspirin trial investigates whether regular aspirin use after standard therapy prevents recurrence and prolongs survival in participants with four non-metastatic common solid tumours.

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“…A large meta-analysis by the US Preventative Task Force of 33 studies showed that regular aspirin use appeared to decrease the incidence of colon cancer [94]. Another Norwegian population based study of patients previously diagnosed with colon cancer, showed a dramatic improvement in both cancer specific survival (HR: 0.53; 95% CI: 0.50-0.57; p < 0.001) and OS (HR: 0.71; 95% CI: 0.68-0.75; p < 0.001) for those patients regularly using ASA [95]. In patients with adenomas identified on colonoscopy, use of rofecoxib, a selective COX-2 inhibitor, was shown to decrease the risk of adenoma recurrence (from 55 to 41%; p < 0.0001) at both 1 and 3 years following initial colonoscopy in a randomized controlled trial [96].…”

Section: • • Chemoprevention Of Recurrencementioning

confidence: 93%

Optimizing Adjuvant Therapy and Survivorship Care of Stage III Colon Cancer

Loree

Cheung

2016

Future Oncol.

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The MOSAIC trial demonstrated nearly a decade ago that the addition of oxaliplatin to 5-fluorouracil improves outcomes in the adjuvant treatment of colon cancer, but no new agents have been shown to be superior to standard FOLFOX therapy. Oncologists have refined the use of oxaliplatin containing regimens to optimize outcomes, improved patient selection for multi-agent chemotherapy and expanded survivorship care to meet the needs of the growing number of survivors. In this article, we review the historical contexts of current therapy, appropriate staging investigations, the importance of timely initiation of therapy and key survivorship issues. We also discuss exciting opportunities for change, including reduced duration of adjuvant chemotherapy and the use of circulating tumor cells and DNA in surveillance.

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Impact of aspirin as secondary prevention in an unselected cohort of 25,644 patients with colorectal cancer: A population-based study.

Cited by 6 publications

References 0 publications

Aspirin in the Treatment of Cancer: Reductions in Metastatic Spread and in Mortality: A Systematic Review and Meta-Analyses of Published Studies

Aspirin in the Treatment of Cancer: Reductions in Metastatic Spread and in Mortality: A Systematic Review and Meta-Analyses of Published Studies

ADD-ASPIRIN: A phase III, double-blind, placebo controlled, randomised trial assessing the effects of aspirin on disease recurrence and survival after primary therapy in common non-metastatic solid tumours

Optimizing Adjuvant Therapy and Survivorship Care of Stage III Colon Cancer

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