Аспирин для профилактики колоректальных неоплазий.

[Tesora]

Кто практикует?

http://www.clinicaloncology.com/ViewArt ... a_id=24468

[Александр Петрушин]

В первой ссылке требует пароль, а вторая не открывается.

[Tesora]

Вторая ссылка у меня открывается

Первую копирую сюда:

Low-Dose Aspirin Reduces Extent of Colorectal, Lung Tumors
From the British Journal of Cancer

Long-term, low-dose aspirin use was associated with lower tumor extent in a population-based study of patients with colorectal and lung cancers. The study did not find a similar benefit for patients with prostate or breast cancers.

Researchers from the Karolinska Institutet in Stockholm abstracted disease information from the Swedish Cancer Registry for more than 76,000 newly diagnosed patients with cancer of the breast, prostate, colon or rectum, and lung, between 2006 and 2009. Primary cancer information gathered included tumor extent (T1-T4), node status (N0-N2) and distant metastases (M0-M1). Additionally, patients’ age, sex, educational status and residence (rural vs. nonrural) were noted because it was felt these factors might confound results.

The Swedish Prescribed Drug Registry contains information on drugs sold by pharmacies. The researchers, whose principal author was Fredrik Jonsson, PhD, estimated the registry captures 95% of daily doses dispensed. They found more than 17 million records of low-dose aspirin prescribed between 2005 and 2009 and identified patients who took a low-dose aspirin regimen for at least one year before their cancer diagnosis. Patients who averaged at least one tablet (75 mg) per day were compared with patients who did not have a history of aspirin use.

The results, published in the British Journal of Cancer (2013 July 25. [Epub ahead of print], PMID: 23887604), showed that about 26% of patients diagnosed with colorectal, lung or prostate cancer used regular low-dose aspirin; among patients with breast cancer, that figure was about 14%. The authors found a significant association between aspirin use and tumor extent in colorectal and lung cancers (P<0.0001), but not in cancers of the prostate or breast (P>0.05). For patients with colorectal cancer, aspirin use was associated with about a 30% reduction in the odds of getting a T4 tumor. The authors noted that these results might suggest some early and late protective effects of aspirin in patients with certain cancers. There was no association with aspirin and nodal involvement for any cancer.

EXPERT INSIGHT
Andrew T. Chan, MD
Program Director
Gastroenterology Training Program
Massachusetts General Hospital
Boston, Massachusetts

R emarkably consistent experimental and epidemiologic evidence demonstrates that aspirin is associated with a lower risk for developing colorectal cancer.1 As compelling proof of causality, four randomized controlled trials have shown that aspirin reduces the risk for recurrent adenoma, the precursor for the vast majority of colorectal cancer.2 Recently, secondary analyses of randomized trials conducted for the prevention of vascular disease also have demonstrated that aspirin reduces risk for not only colorectal cancer, but also many other cancers.3-5 Based on this data relating aspirin to cancer incidence, identifying a potential role for aspirin for treatment of cancer among patients with established cancer has been an area of intensive investigation.

The results of Jonsson et al add to a growing body of evidence supporting a role for aspirin in improving survival among patients with cancer, particularly of the colorectum.6-8 The strengths of this analysis include the large number of patients derived from a real-world population rather than a referral center. Additionally, the study was able to estimate aspirin exposure by tallying prescriptions through a national prescription registry within a country in which low-dose aspirin is rarely purchased over the counter. Limitations include a lack of information on actual consumption of aspirin, inability to assess aspirin use after as well as before cancer diagnosis, lack of data on survival outcomes and the relatively short follow-up (three years). Moreover, similar to prior studies that addressed this hypothesis, the analysis by Jonsson et al was observational, precluding any firm conclusions about whether aspirin should be generally recommended for cancer treatment.

Nonetheless, based on the consistency of these results with prior studies as well as compelling experimental and mechanistic data supporting an effect of aspirin in abrogating the progression and spreading of tumors, the study by Jonsson et al should provide an even stronger rationale for further study of aspirin as a treatment for cancer.9,10 Currently, there are two ongoing trials of aspirin among patients with established colorectal and non-small cell lung cancer, as well as a planned trial for patients with colorectal, prostate, gastroesophageal and breast cancers.9,11,12 However, because many patients with cancer and their physicians cannot afford to wait for the results of such studies, it is not unreasonable to discuss the known risks and potential benefits of aspirin use for cancer treatment within the context of the current state of the evidence.

References

Chan AT, Arber N, Burn J, et al. Aspirin in the chemoprevention of colorectal neoplasia: an overview. Cancer Prev Res (Phila). 2012;5:164-178, PMID: 22084361.
Cole BF, Logan RF, Halabi S, et al. Aspirin for the chemoprevention of colorectal adenomas: meta-analysis of the randomized trials. J Natl Cancer Inst. 2009;101:256-266, PMID: 19211452.
Rothwell PM, Fowkes FG, Belch JF, et al. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet. 2011;377:31-41, PMID: 21144578.
Rothwell PM, Price JF, Fowkes FG, et al. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet. 2012;379:1602-1612, PMID: 22440946.
Rothwell PM, Wilson M, Elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet. 2010;376:1741-1750, PMID: 20970847.
Chan AT, Ogino S, Fuchs CS. Aspirin use and survival after diagnosis of colorectal cancer. JAMA. 2009;302:649-658, PMID: 19671906.
Liao X, Lochhead P, Nishihara R, et al. Aspirin use, tumor PIK3CA mutation, and colorectal-cancer survival. N Engl J Med. 2012;367:1596-1606, PMID: 23094721.
Rothwell PM, Wilson M, Price JF, et al. Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. Lancet. 2012;379:1591-1601, PMID: 22440947.
Thun MJ, Jacobs EJ, Patrono C. The role of aspirin in cancer prevention. Nat Rev Clin Oncol. 2012;9:259-267, PMID: 22473097.
Langley RE, Burdett S, Tierney JF, et al. Aspirin and cancer: has aspirin been overlooked as an adjuvant therapy? Br J Cancer. 2011;105:1107-1113, PMID: 21847126.
Ali R, Toh HC, Chia WK, et al. The utility of Aspirin in Dukes C and High Risk Dukes B Colorectal cancer—the ASCOLT study: study protocol for a randomized controlled trial. Trials. 2011;12:261, PMID: 22168568.
Fontaine E, McShane J, Page R, et al. Aspirin and non-small cell lung cancer resections: effect on long-term survival. Eur J Cardiothorac Surg. 2010;38:21-26, PMID: 20359903.

Dr. Chan reported no relevant financial disclosures.

[Аирмед]

Это уже не новость.
Единственный вопрос, насколько реальные побочные эффекты ДЛИТЕЛЬНОГО приема аспирина лучше потенциальной опасности развития неоплазии.

[Tesora]

А вопрос про новость и не стоял
Вот Ваш вопрос по крайней мере странен. Ни разу не слышал про длительный приём аспирина?

[Александр Петрушин]

Интересно! Жаль не указано какой аспирин давали (ну там кардиомагнил, тромбоАСС и т.д).

[Tesora]

Ecть на итальянском:

http://www.quotidianosanita.it/scienza- ... lo_id=8066

Аспирин обычный или кардио, НПВС имеют такой же эффект.

[Александр Петрушин]

Обычного аспирина, как впрочем и других препаратов, не существует. Различные дженерики сильно отличаются друг от друга по свойствам. Интересная лекция на эту тему есть на MD TUBE RUS. Вот одна из выдержек из лекции - содержание препарата согласно Российским нормативным актам, допускается от 70 до 140% от указанной дозировки.

[Felix Augustus]

[Tesora]

Если условно здоровому человеку просать аспирин на 10 лет для профилактики неоплазии, то, конечно, вопрос о целесообразности важен.
Если пациент уже на химиотерапии или принимает принимает аспирин по другим причинам, то прием аспирина обсуждать речь не идет.
Я именно о таких пациентах говорила. Назначать аспирин всем подряд мне как-то на ум не пришло.
Наши онкологи аспирин не практикуют. Исследований было не мало. А на практике кто-то применяет?

[Tesora]

Да, омепразол еще никто не отменял. Правда, многие его и не применяли никогда.

[Алекс]

[Аирмед]

К вопросу об оптимальной профилактической дозе аспирина. Вторичный анализ исследования CHARISMА - http://www.airmed.com.ua/forum/index.php?showtopic=5846