From the Desk of Dr. Lenz

Aspirin for Every Patient with Metastatic Colon Cancer?

A recent study suggested that patients with colon cancer lived longer when taking aspirin.

Aspirin is a very interesting drug which has showed to reduce the risk of cardiovascular disease and colon cancer risk and is a great pain reliever. The mechanism of action is the inhibition of an enzyme called COX-2.

However aspirin also inhibits COX-1 which is thought to be responsible for some of its side effects such as stomach ulcers, bleeding disorders and kidney problems. Therefore major pharmaceutical companies have developed specific COX-2 inhibitors to have the great benefits but not the side effects. These drugs are known as Celebrex and Vioxx.

It was shocking to see the results from the large VICTOR trial testing Vioxx in patients with colon cancer who had successful resection and adjuvant chemotherapy. This trial enrolled 1167 patients and 23 cardiovascular thrombotic events occurred (heart attacks), 16 were in the Vioxx group and 7 in the placebo group. Statistically this was highly significant making it an estimated risk of 2.66 which means increase by 266 percent. These data were the end of the COX-2 inhibitors in the chemoprevention world.

The newest study on aspirin shows clearly that the inhibition of these enzymes may benefit patients with active disease. Dr. Chan showed in 1300 patients with colon cancer were nearly 30% less likely to die from their cancer.

How aspirin works, we don’t know. It can prevent blood clots, but COX-2 is directly involved in inflammation which can be part of cancer, and invasion and metastases. These data warrant further studies of the role of these drugs for patients with colon cancer.

I discuss and use baby aspirin  for many of my patients but also let them know about the potential risk factors. For example someone with bleeding problems or stomach ulcer or kidney function problems would be not great candidate. However for patients on Avastin I do consider aspirin to potentially reduce the risk for heart attack and strokes.

Please discuss these findings with your treating oncologists.

This news article was originally posted on August 31st, 2009 and was accurate at the time of publication. Since then, information may have changed or links may now be outdated. Please call our Answer Line 1-877-427-2111 for the latest information, or talk to your doctor before making any medical decisions.

Posted by Heinz-Josef Lenz, MD on August 31st, 2009
Tags: aspirin, chemoprevention, survival, Treating Colorectal Cancer

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