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Cancer occurrence during follow-up of the CAPP2 study -aspirin use for up to four years significantly reduces Lynch syndrome cancers for up to several years after completion of therapy

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Background/methods

The CAPP2 Study evaluated 600mg enteric coated aspirin and/or 30gms of Novelose (resistant starch) in a double blind factorial RCT in 1071 carriers of Lynch syndrome over a treatment period of 1 to 4 years, mean 29 months.

Results

The trial, reported in December 2008 [1], showed that there was no difference between the treatment and placebo groups for new colorectal neoplasia. Follow-up data for 667 participants for up to 120 months (mean 51m) is now available. Analysis reveals a striking reduction in subsequent cancers; overall, 102 participants have developed 110 Lynch syndrome cancers. Despite equal numbers being randomised to aspirin or placebo, cancer sufferers in the aspirin group are outnumbered 2 to 1. Lifetable analysis for time to first Lynch syndrome cancer reveals a hazard ration of 0.62(0.41, 0.96)p=0.03. There is a clear effect of duration of treatment: <24months on treatment OR 0.90 (0.45, 1.81) p=0.78, treated >24 months OR 0.50 (0.28, 0.86) p=0.01.

Conclusions

All carriers of Lynch syndrome should consider aspirin chemoprevention. A dose finding study, CAPP3, is under development. It will compare different doses of aspirin over a 5 to 10 year period.

Funding provided by the UK Medical Research Council, Cancer Research UK, EU Framework and Bayer Corp.

References

  1. 1.

    Bum J, Bishop DT, Mecklin JP, et al.: Effect of aspirin or resistant starch on colorectal neoplasia in the Lynch Syndrome. NEJM 2008,359(24):2567–78. 10.1056/NEJMoa0801297

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Author information

Correspondence to John Burn.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Keywords

  • Aspirin
  • Lynch Syndrome
  • Resistant Starch
  • Dose Finding Study
  • Colorectal Neoplasia