colorectal cancer
Research
Treatment
Source: Cancer Letters
NSAIDs and cancer
In a nutshell
This review analyzed a number of studies which evaluated the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on cancers of the gastrointestinal system, such as colorectal cancer.
Some background
NSAIDs, such as aspirin and ibuprofen (Advil), are a class of drugs commonly used for pain relief and fever reduction. NSAIDs exert their anti-inflammatory effect effects through the inhibition of the cyclooxygenase-2 (COX-2) enzyme. COX-2 activity and inflammation appear to be related to the development and growth of gastrointestinal cancers. Recent studies have found that COX-2 is found in higher amounts in faster developing colorectal cancers. A mutation in the gene responsible for the production of COX-2, the PIK3CA gene, is also commonly found in some colorectal cancer cells. COX-2 also appears to be involved in the growth of new blood vessels, which are essential for cancer growth and spread. While several past studies have demonstrated that regular use of NSAIDs reduces the risk of developing colorectal cancer, the use of NSAIDs as part of treatment after cancer diagnosis is still being investigated.
Methods & findings
Three of the studies reviewed found that regular use of aspirin after diagnosis of colorectal cancer was associated with a lower risk of overall mortality (mortality from any cause, including cancer). One of the reviewed studies showed that in patients with tumors who express high levels of the COX-2 enzyme, the use of aspirin after diagnosis reduced both the risk of cancer-specific, and overall, mortality. A recent study indicates that colorectal cancer patients with a PIK3CA mutation who regularly use aspirin experience higher survival rates compared to colorectal cancer patients without the PIK3CA mutation.
The bottom line
This review concluded that regular use of NSAIDs, and specifically aspirin, may improve survival among colorectal cancer patients. Recent evidence suggests that aspirin should be seriously considered in the treatment of PIK3CA-mutated or high COX-2 expressing colorectal cancers.
The fine print
Further controlled studies are required to determine the long term effects and optimal dosage of NSAIDs as added colorectal cancer treatment. Since NSAID use has been shown to reduce the risk of developing colorectal cancer, it is assumed that NSAIDs may also reduce recurrence rates among cancer survivors, although this has yet to be investigated.
What's next?
Consult with your physician regarding the risks and benefits of NSAIDs in the treatment of colorectal cancer.
Disclaimer:
This information should not be relied upon as a substitute for personal medical advice, diagnosis or treatment. Use the information provided by Medivizor solely at your own risk. Medivizor makes no warranties or representations as to the accuracy of information provided herein. If you have any concerns about your health, please consult a physician.
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But what size aspirin...81 or 325 mg Reply
In this review the dosages of aspirin varied between studies and patients. Non of the reviewed studies were controlled trials administering constant doses of the drug, but rather investigated patients receiving NSAIDs for other conditions in addition to cancer treatments. As was mentioned in the fine print section, further controlled studies are required to determine the optimal dosage, timing and long term effect of NSAIDs as added colorectal cancer treatment. Some randomized controlled clinical trials are currently underway, and Medivizor users will receive updates as soon as results of these trials are published. Reply
100-150 my per day is similarly effective to 300 mg in vascular patients, where it is affecting platelets. Given that the study was looking at recurrence in patients taking aspirin for other reasons, it is probably reasonable to expect half a 325 mg tab is as effective as a a whole one. This also helps reduce the side effects (eg easy bruising). Optimum dosing and timing is unknown however, as stated above. Add in the low carb diet and keep fit to amplify any benefit. Reply
Seem to be conflicting theories on the use of aspirin. Reply
I've just finished my treatment and my oncologist suggested taking an 81 mg aspirin every day, but it seems like half of the 325 might be better. Does anyone know more? Reply
I have a patient affected by mCRC , who never assumed NSAIDs in her life. She is now 65 year old and has a metastatic colon cancer from 1 year. It is rational to suggest a chronic therapy with aspirin o ibuprofen?
Angelo Forgione MD, PhD, MSc Reply
Hi Forang39, this review noted that “observational epidemiological studies and clinical trials strongly suggest that NSAIDs and aspirin in particular, have a preventative effect against the development and progression of colorectal cancer”. However, the benefit of post-diagnosis aspirin use remains an open question, as conclusive high-quality evidence is lacking. The potential harms of chronic low-dose aspirin use should be weighed against the potential benefits in the case of each individual patient. Please note that Medivizor does not offer nor substitute medical advice or diagnosis. Medivizor does not practice or provide medical services. While we hope you benefit from the information and services we provide, be aware that you are doing so at your sole discretion. Reply
Thank you
Angelo Forgione MD, PhD, MSc Reply