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Effect of daily aspirin on risk of cancer metastasis

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Effect of daily aspirin on risk of cancer metastasis : a study of incident cancers during randomised controlled trials. / Rothwell, Peter M.; Wilson, Michelle; Price, Jacqueline F.; Belch, Jill F. F.; Meade, Tom W.; Mehta, Ziyah.

In: Lancet, Vol. 379, No. 9826, 28.04.2012, p. 1591-1601.

Research output: Contribution to journalArticle

Harvard

Rothwell, PM, Wilson, M, Price, JF, Belch, JFF, Meade, TW & Mehta, Z 2012, 'Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials' Lancet, vol 379, no. 9826, pp. 1591-1601., 10.1016/S0140-6736(12)60209-8

APA

Rothwell, P. M., Wilson, M., Price, J. F., Belch, J. F. F., Meade, T. W., & Mehta, Z. (2012). Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. Lancet, 379(9826), 1591-1601. 10.1016/S0140-6736(12)60209-8

Vancouver

Rothwell PM, Wilson M, Price JF, Belch JFF, Meade TW, Mehta Z. Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. Lancet. 2012 Apr 28;379(9826):1591-1601. Available from: 10.1016/S0140-6736(12)60209-8

Author

Rothwell, Peter M.; Wilson, Michelle; Price, Jacqueline F.; Belch, Jill F. F.; Meade, Tom W.; Mehta, Ziyah / Effect of daily aspirin on risk of cancer metastasis : a study of incident cancers during randomised controlled trials.

In: Lancet, Vol. 379, No. 9826, 28.04.2012, p. 1591-1601.

Research output: Contribution to journalArticle

Bibtex - Download

@article{5bdf75fe92d0499f8fa786ef7ea7fb83,
title = "Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials",
author = "Rothwell, {Peter M.} and Michelle Wilson and Price, {Jacqueline F.} and Belch, {Jill F. F.} and Meade, {Tom W.} and Ziyah Mehta",
year = "2012",
doi = "10.1016/S0140-6736(12)60209-8",
volume = "379",
number = "9826",
pages = "1591--1601",
journal = "Lancet",
issn = "0140-6736",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Effect of daily aspirin on risk of cancer metastasis

T2 - a study of incident cancers during randomised controlled trials

A1 - Rothwell,Peter M.

A1 - Wilson,Michelle

A1 - Price,Jacqueline F.

A1 - Belch,Jill F. F.

A1 - Meade,Tom W.

A1 - Mehta,Ziyah

AU - Rothwell,Peter M.

AU - Wilson,Michelle

AU - Price,Jacqueline F.

AU - Belch,Jill F. F.

AU - Meade,Tom W.

AU - Mehta,Ziyah

PY - 2012/4/28

Y1 - 2012/4/28

N2 - <p>Background Daily aspirin reduces the long-term incidence of some adenocarcinomas, but effects on mortality due to some cancers appear after only a few years, suggesting that it might also reduce growth or metastasis. We established the frequency of distant metastasis in patients who developed cancer during trials of daily aspirin versus control.</p><p>Methods Our analysis included all five large randomised trials of daily aspirin (&gt;= 75 mg daily) versus control for the prevention of vascular events in the UK. Electronic and paper records were reviewed for all patients with incident cancer. The effect of aspirin on risk of metastases at presentation or on subsequent follow-up (including post-trial follow-up of in-trial cancers) was stratified by tumour histology (adenocarcinoma vs other) and clinical characteristics.</p><p>Findings Of 17 285 trial participants, 987 had a new solid cancer diagnosed during mean in-trial follow-up of 6.5 years (SD 2.0). Allocation to aspirin reduced risk of cancer with distant metastasis (all cancers, hazard ratio [HR] 0.64, 95% CI 0.48-0.84, p=0.001; adenocarcinoma, HR 0.54, 95% CI 0.38-0.77, p=0.0007; other solid cancers, HR 0.82, 95% CI 0.53-1.28, p=0.39), due mainly to a reduction in proportion of adenocarcinomas that had metastatic versus local disease (odds ratio 0.52, 95% CI 0.35-0.75, p=0.0006). Aspirin reduced risk of adenocarcinoma with metastasis at initial diagnosis (HR 0.69, 95% CI 0.50-0.95, p=0.02) and risk of metastasis on subsequent follow-up in patients without metastasis initially (HR 0.45, 95% CI 0.28-0.72, p=0.0009), particularly in patients with colorectal cancer (HR 0.26, 95% CI 0.11-0.57, p=0.0008) and in patients who remained on trial treatment up to or after diagnosis (HR 0.31, 95% CI 0.15-0.62, p=0.0009). Allocation to aspirin reduced death due to cancer in patients who developed adenocarcinoma, particularly in those without metastasis at diagnosis (HR 0.50, 95% CI 0.34-0.74, p=0.0006). Consequently, aspirin reduced the overall risk of fatal adenocarcinoma in the trial populations (HR 0.65, 95% CI 0.53-0.82, p=0.0002), but not the risk of other fatal cancers (HR 1.06, 95% CI 0.84-1.32, p=0.64; difference, p=0.003). Effects were independent of age and sex, but absolute benefit was greatest in smokers. A low-dose, slow-release formulation of aspirin designed to inhibit platelets but to have little systemic bioavailability was as effective as higher doses.</p><p>Interpretation That aspirin prevents distant metastasis could account for the early reduction in cancer deaths in trials of daily aspirin versus control. This finding suggests that aspirin might help in treatment of some cancers and provides proof of principle for pharmacological intervention specifically to prevent distant metastasis.</p>

AB - <p>Background Daily aspirin reduces the long-term incidence of some adenocarcinomas, but effects on mortality due to some cancers appear after only a few years, suggesting that it might also reduce growth or metastasis. We established the frequency of distant metastasis in patients who developed cancer during trials of daily aspirin versus control.</p><p>Methods Our analysis included all five large randomised trials of daily aspirin (&gt;= 75 mg daily) versus control for the prevention of vascular events in the UK. Electronic and paper records were reviewed for all patients with incident cancer. The effect of aspirin on risk of metastases at presentation or on subsequent follow-up (including post-trial follow-up of in-trial cancers) was stratified by tumour histology (adenocarcinoma vs other) and clinical characteristics.</p><p>Findings Of 17 285 trial participants, 987 had a new solid cancer diagnosed during mean in-trial follow-up of 6.5 years (SD 2.0). Allocation to aspirin reduced risk of cancer with distant metastasis (all cancers, hazard ratio [HR] 0.64, 95% CI 0.48-0.84, p=0.001; adenocarcinoma, HR 0.54, 95% CI 0.38-0.77, p=0.0007; other solid cancers, HR 0.82, 95% CI 0.53-1.28, p=0.39), due mainly to a reduction in proportion of adenocarcinomas that had metastatic versus local disease (odds ratio 0.52, 95% CI 0.35-0.75, p=0.0006). Aspirin reduced risk of adenocarcinoma with metastasis at initial diagnosis (HR 0.69, 95% CI 0.50-0.95, p=0.02) and risk of metastasis on subsequent follow-up in patients without metastasis initially (HR 0.45, 95% CI 0.28-0.72, p=0.0009), particularly in patients with colorectal cancer (HR 0.26, 95% CI 0.11-0.57, p=0.0008) and in patients who remained on trial treatment up to or after diagnosis (HR 0.31, 95% CI 0.15-0.62, p=0.0009). Allocation to aspirin reduced death due to cancer in patients who developed adenocarcinoma, particularly in those without metastasis at diagnosis (HR 0.50, 95% CI 0.34-0.74, p=0.0006). Consequently, aspirin reduced the overall risk of fatal adenocarcinoma in the trial populations (HR 0.65, 95% CI 0.53-0.82, p=0.0002), but not the risk of other fatal cancers (HR 1.06, 95% CI 0.84-1.32, p=0.64; difference, p=0.003). Effects were independent of age and sex, but absolute benefit was greatest in smokers. A low-dose, slow-release formulation of aspirin designed to inhibit platelets but to have little systemic bioavailability was as effective as higher doses.</p><p>Interpretation That aspirin prevents distant metastasis could account for the early reduction in cancer deaths in trials of daily aspirin versus control. This finding suggests that aspirin might help in treatment of some cancers and provides proof of principle for pharmacological intervention specifically to prevent distant metastasis.</p>

U2 - 10.1016/S0140-6736(12)60209-8

DO - 10.1016/S0140-6736(12)60209-8

M1 - Article

JO - Lancet

JF - Lancet

SN - 0140-6736

IS - 9826

VL - 379

SP - 1591

EP - 1601

ER -

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