The preventive effects of low-dose enteric-coated aspirin tablets on the development of colorectal tumours in Asian patients: a randomised trial

Ishikawa, Hideki; Mutoh, Michihiro; Suzuki, Sadao; Tokudome, Shinkan; Saida, Yoshihisa; Abe, Takashi; Okamura, Shozo; Tajika, Masahiro; Joh, Takashi; Tanaka, Shinji; Kudo, Shin‐ei; Matsuda, Takahisa; Iimuro, Masaki; Yukawa, Tomomi; Takayama, Tetsuji; Sato, Yasushi; Lee, Kyowon; Kitamura, Shinji; Mizuno, Motowo; Sano, Yasushi; Gondo, Nobuhisa; Sugimoto, Kenji; Kusunoki, Masato; Goto, Chiho; Matsuura, Nariaki; Sakai, Toshiyuki; Wakabayashi, Keiji

doi:10.1136/gutjnl-2013-305827

Cited by 108 publications

(107 citation statements)

References 28 publications

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“…Although the dose of aspirin and other aspects of these RCTs varied, the efficacy of aspirin was essentially consistent, providing a modest 17-35% reduction in risk of recurrent adenoma or carcinoma Benamouzig et al, 2003;Sandler et al, 2003). These results have been confirmed in Asian patients as well (Ishikawa et al, 2014).…”

Section: Evolving Role Of Nsaids In Colon Cancer Preventionsupporting

confidence: 66%

The Evolving Role of Nonsteroidal Anti-Inflammatory Drugs in Colon Cancer Prevention: A Cause for Optimism

Rigas

Tsioulias

2015

J Pharmacol Exp Ther

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Colorectal cancer (CRC) is a serious yet preventable disease. The low acceptance and cost of colonoscopy as a screening method for CRC make chemoprevention an important option. Nonsteroidal anti-inflammatory drugs (NSAIDs), not currently recommended for CRC prevention, have the potential to evolve into the agents of choice for this indication. Here, we discuss the promise and challenge of NSAIDs for this chemopreventive application. Multiple epidemiologic studies, randomized clinical trials (RCTs) of sporadic colorectal polyp recurrence, RCTs in patients with hereditary colorectal cancer syndromes, and pooled analyses of cardiovascular-prevention RCTs linked to cancer outcomes have firmly established the ability of conventional NSAIDs to prevent CRC. NSAIDs, however, are seriously limited by their toxicity, which can become cumulative with their long-term administration for chemoprevention, whereas drug interactions in vulnerable elderly patients compound their safety. Newer, chemically modified NSAIDs offer the hope of enhanced efficacy and safety. Recent work also indicates that targeting earlier stages of colorectal carcinogenesis, such as the lower complexity aberrant crypt foci, is a promising approach that may only require relatively short use of chemopreventive agents. Drug combination approaches exemplified by sulindac plus difluoromethylornithine appear very efficacious. Identification of those at risk or most likely to benefit from a given intervention using predictive biomarkers may usher in personalized chemoprevention. Agents that offer simultaneous chemoprevention of diseases in addition to CRC, e.g., cardiovascular and/or neurodegenerative diseases, may have a much greater potential for a broad clinical application.

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Section: Evolving Role Of Nsaids In Colon Cancer Preventionsupporting

confidence: 66%

The Evolving Role of Nonsteroidal Anti-Inflammatory Drugs in Colon Cancer Prevention: A Cause for Optimism

Rigas

Tsioulias

2015

J Pharmacol Exp Ther

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“…Human/laboratory studies [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] also suggested that n-3 PUFAs (or omega-3 PUFAs), including alpha-linolenic acid (ALA) and long-chain n-3 PUFAs (LC n-3 PUFAs) (eicosapentaenoic acid [EPA], docosapentaenoic acid [DPA], and docosahexaenoic acid [DHA]) seem to act as anti-tumor promoters in CRC carcinogenesis, like non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin [29][30][31][32][33][34][35][36][37][38]. On the other hand, n-6 PUFAs (or omega-6 PUFAs, mainly linoleic acid (LA)) may act as tumor promoters, because they are upstream chemicals of n-6 family leukotrienes, thromboxanes and prostaglandins, which are catalyzed by lipoxygenase (LOX) and cyclooxygenase (COX) isoenzymes [39][40][41][42][43].…”

mentioning

confidence: 99%

Dietary n-3/long-chain n-3 polyunsaturated fatty acids for prevention of sporadic colorectal tumors: A randomized controlled trial in polypectomized participants

Tokudome

Kuriki

Yokoyama

et al. 2015

Prostaglandins, Leukotrienes and Essential Fatty Acids

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“…A large collection of observational epidemiological studies [155][156][157][158], long-term follow-up for cancer of randomised primary prevention [159] or cardiovascular [160,161] trials, randomised trials on colon adenoma recurrence [162][163][164][165][166], and randomised trials in patients with hereditary colorectal cancer syndromes [167,168] have established that use of aspirin or other NSAIDs reduce the risk of colorectal neoplasia and cancer. There is also substantial evidence to suggest that use of aspirin or non-aspirin NSAIDs may protect against upper gastrointestinal cancers, including oesophageal and gastric cancer [158,[169][170][171][172].…”

Section: Aspirin and Other Non-steroidal Anti-inflammatory Drugsmentioning

confidence: 99%

European Code against Cancer 4th Edition: Medical exposures, including hormone therapy, and cancer

Friis

Kesminiene

Espina

et al. 2015

Cancer Epidemiology

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The 4th edition of the European Code against Cancer recommends limiting - or avoiding when possible - the use of hormone replacement therapy (HRT) because of the increased risk of cancer, nevertheless acknowledging that prescription of HRT may be indicated under certain medical conditions. Current evidence shows that HRT, generally prescribed as menopausal hormone therapy, is associated with an increased risk of cancers of the breast, endometrium, and ovary, with the risk pattern depending on factors such as the type of therapy (oestrogen-only or combined oestrogen-progestogen), duration of treatment, and initiation according to the time of menopause. Carcinogenicity has also been established for anti-neoplastic agents used in cancer therapy, immunosuppressants, oestrogen-progestogen contraceptives, and tamoxifen. Medical use of ionising radiation, an established carcinogen, can provide major health benefits; however, prudent practices need to be in place, with procedures and techniques providing the needed diagnostic information or therapeutic gain with the lowest possible radiation exposure. For pharmaceutical drugs and medical radiation exposure with convincing evidence on their carcinogenicity, health benefits have to be balanced against the risks; potential increases in long-term cancer risk should be considered in the context of the often substantial and immediate health benefits from diagnosis and/or treatment. Thus, apart from HRT, no general recommendations on reducing cancer risk were given for carcinogenic drugs and medical radiation in the 4th edition of European Code against Cancer. It is crucial that the application of these measures relies on medical expertise and thorough benefit-risk evaluation. This also pertains to cancer-preventive drugs, and self-medication with aspirin or other potential chemopreventive drugs is strongly discouraged because of the possibility of serious, potentially lethal, adverse events.

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The preventive effects of low-dose enteric-coated aspirin tablets on the development of colorectal tumours in Asian patients: a randomised trial

Cited by 108 publications

References 28 publications

The Evolving Role of Nonsteroidal Anti-Inflammatory Drugs in Colon Cancer Prevention: A Cause for Optimism

The Evolving Role of Nonsteroidal Anti-Inflammatory Drugs in Colon Cancer Prevention: A Cause for Optimism

Dietary n-3/long-chain n-3 polyunsaturated fatty acids for prevention of sporadic colorectal tumors: A randomized controlled trial in polypectomized participants

European Code against Cancer 4th Edition: Medical exposures, including hormone therapy, and cancer

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