In Lynch syndrome, aspirin prevents colorectal cancer

  • Burn J & al.
  • Lancet
  • 13 Jun 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Long-term follow-up shows that aspirin reduces colorectal cancer incidence in Lynch syndrome.

Why this matters

  • The authors say there is now a “strong case” for prescribing aspirin to young adults with a germline DNA mismatch repair gene defect.

Study design

  • ≥10-year follow-up data from a multicenter randomized controlled trial (CAPP2; N=861).
  • Participants were randomly assigned to receive daily aspirin (2 doses per day; 300 mg each) or placebo.
  • Funding: Cancer Research UK; European Union; Bayer Pharma AG; Barbour Foundation, others.

Key results

  • At 2 years, there was no significant between-group difference in the frequency of a combined measure including colorectal adenoma and carcinoma formation.
  • An intention-to-treat analysis showed a protective effect of aspirin against colorectal cancer (HR, 0.65; P=.035).
  • A negative binomial regression that looked at all primary cancer diagnoses in the Lynch syndrome spectrum found a protective effect against cancer (incidence rate ratio, 0.58; P=.0085).
  • When the analysis was limited to participants who received aspirin for at least 2 years, the protective effect was similar (HR, 0.56; P=.019).
  • The 2 groups had similar frequencies of adverse events.

Limitations

  • Adenoma data are incomplete, forcing the analysis to be restricted to cancer as an endpoint.