The content of this website is intended for healthcare professionals only

Taking aspirin with a PPI reduces risk of oesophageal cancer

Patients with Barrett’s oesophagus who took esomeprazole 40 mg and low dose aspirin had a 20% reduced risk

Ingrid Torjesen

Tuesday, 05 June 2018

Taking low dose aspirin in combination with a proton pump inhibitor (PPI) to suppress acid can prevent oesophageal cancer in people with a high risk of the disease, show the results of a study* presented at the American Society of Clinical Oncology (ASCO) conference in Chicago yesterday.

In the ASPECT trial 2,563 patients with Barrett’s oesophagus being treated at Canadian and British hospitals were randomised to receive either 20 or 40mg of the PPI esomeprazole, with or without a low dose of aspirin.

Patients with Barrett’s are at around a fifty times greater risk of oesophageal cancer, and around one in 50 will go on to develop the disease. Of those who do develop cancer, only 12% will survive for 10 years or more.

The researchers followed the four groups of patients for an average of 8.9 years. They found the most effective combination was high dose esomeprazole with low dose aspirin, followed by high dose esomeprazole. Patients who took the high dose of esomeprazole (40mg) plus aspirin combination for at least seven years were 20% less likely to develop oesophageal cancer than if they had been untreated.

Professor Janusz Jankowski, lead author of the study and Cancer Research UK funded researcher at the Royal College of Surgeons, Ireland, and the National Institute for Health and Care Excellence, UK, said: “Our results are very exciting. Oesophageal cancer is hard to diagnose and hard to treat. So, we’re pleased that such a cheap and well-established medicine can prevent and/or delay development of cancer for these patients. Our hope is that this may also offer an opportunity to prevent oesophageal cancer in wider populations.”

Currently patients with Barrett’s oesophagus are monitored using endoscopy for neoplastic lesions but this approach has “a modest” impact on outcomes and is “supported by low quality evidence”.

Dr Justine Alford, from Cancer Research UK, said: “Oesophageal cancer can be hard to diagnose at an early stage and so can be hard to treat; there hasn’t been a significant improvement in survival for decades. Cancer Research UK has therefore identified oesophageal cancer as a cancer of unmet need, along with brain tumours, lung cancer, and pancreatic cancer. We will increase our investment in researching these cancers two- to threefold over the next five years.”

*Jankowski J, Caestecker J de, Love S, et al. Chemoprevention of esophageal cancer with esomeprazole and aspirin therapy: Efficacy and safety in the phase III randomized factorial ASPECT trial. Presented at the 2018 ASCO Annual meeting, 4 June 2018.

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470