Colorectal Cancer: A Practical Review - Episode 1

Adjuvant Aspirin in Colorectal Cancer

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Adjuvant aspirin could improve outcomes for patients with colorectal cancer (CRC), according to a retrospective study of medical records from 25,644 individuals in Norway. This analysis showed that patients who took aspirin regularly had a lower death rate attributed to colon cancer, says Richard L. Goldberg, MD. In the study, aspirin use was associated with a 14% improvement in overall survival and a 25% improvement in colorectal cancer—specific survival.

This retrospective analysis corroborates findings from other studies that have suggested there is value in cyclooxygenase-2 (COX-2) inhibition in people with a history of colon cancer, notes Goldberg. An ongoing prospective phase III clinical trial is further exploring this relationship between COX-2 inhibition and outcomes by assessing standard therapy with 3 years of placebo versus 3 years of the COX-2 inhibitor celecoxib, notes John L. Marshall, MD (NCT01150045).

Data from a prospective trial will provide stronger evidence than the retrospective epidemiologic data from Norway, comments Howard S. Hochster, MD. While there is strength in the study’s large sample size of more than 25,000, the population was homogenous, states Hochster. Moreover, the study is retrospective, and results were derived from public records that may or may not have been complete.

The optimal dose of adjuvant aspirin (81 mg or 325 mg) in this setting remains unknown. The toxicity associated with full-strength aspirin may not be that much greater than that from baby aspirin, comments Goldberg. At this time, intergroup prospective phase III study is reaching a conclusion, with only a few more patients needing to be enrolled, Goldberg notes.