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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

  • John Burn1Email author,
  • John C Mathers1,
  • Anne-Marie Gerdes1,
  • MarieLuise Bisgaard1,
  • Gareth Evans1,
  • Diana Eccles1,
  • Annika Lindblom1,
  • Findlay Macrae1,
  • Eamonn R Maher1,
  • Jukka-Pekka Mecklin1,
  • Gabriela Moslein1,
  • Sylviane Olschwang1,
  • Raj Ramesar1,
  • Hans FA Vasen1,
  • Juul Wijnen1,
  • Gail Barker1,
  • Faye Elliott1,
  • Henry Lynch1,
  • D Tim Bishop1 and
  • the CAPP2 Consortium1
Hereditary Cancer in Clinical Practice20108(Suppl 1):O5

Published: 25 May 2010


AspirinLynch SyndromeResistant StarchDose Finding StudyColorectal Neoplasia


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.


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.


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.

Authors’ Affiliations

Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, UK


  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/NEJMoa0801297View ArticleGoogle Scholar


© Burn et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.