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In carriers of Lynch syndrome, 600 mg of aspirin a day for about two years reduced colorectal cancer over the following decade (HR 0.65 by intention to treat; 0.56 in those who took it for at least two years).
CAPP2 randomised 861 carriers of a mismatch-repair gene mutation (Lynch syndrome) to aspirin 600 mg daily or placebo for a mean of 25 months, in a factorial design with resistant starch. The pre-specified 10-year follow-up reported here used national registries and questionnaires.
By intention to treat, 40 aspirin-arm and 58 placebo-arm participants developed colorectal cancer (HR 0.65). Among those who completed at least two years of treatment, the hazard ratio was 0.56. The protective effect emerged only after about five years and persisted for at least a decade after stopping. Adverse events did not differ during the treatment period.
The result led NICE and other guidelines to recommend daily aspirin for people with Lynch syndrome; the CAPP3 dose-finding trial (100 vs 300 vs 600 mg) followed.
People with Lynch syndrome should be offered daily aspirin, which roughly halves bowel cancer risk with a delayed and durable effect. Whether a lower dose (as tested in CAPP3) is as effective, and whether the finding extends to the general population, are separate questions.
Shares Lynch syndrome, Chemoprevention & risk-reducing surgery, Germline vs somatic mutations, Mismatch-repair deficient (MSI-high) colorectal cancer.
Shares CAPP2, Get every Lynch syndrome carrier onto the right dose of aspirin, Get biomarker-directed aspirin after colorectal surgery into labels and guidelines, Lynch syndrome.
Shares CAPP2, Aspirin, Lynch syndrome, Colorectal cancer.
Shares Chemoprevention & risk-reducing surgery, Germline vs somatic mutations, Inherited risk is mostly unidentified, Prevention we already have is not deployed.
Shares Get biomarker-directed aspirin after colorectal surgery into labels and guidelines, Aspirin, Germline vs somatic mutations, No incentive to repurpose cheap drugs.
Shares Inherited risk is mostly unidentified, Mismatch-repair deficient (MSI-high) colorectal cancer, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Prevention we already have is not deployed.
Shares Lynch syndrome, Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), Germline vs somatic mutations, Germline (hereditary) testing.
Shares Chemoprevention & risk-reducing surgery, Germline vs somatic mutations, Inherited risk is mostly unidentified, Prevention we already have is not deployed.