Does NSAID Use Impact GI Cancers?

Benefits of NSAID use for gastrointestinal cancers reviewed

(RxWiki News) Aspirin is an intriguing medicine because it helps to control inflammation, which plays a big role in a number of diseases — including cancer. So does aspirin help prevent and treat certain types of cancer?

A new review of the latest research looked at the effect aspirin and other NSAIDs — non-steroidal anti-inflammatory drugs — have on cancers affecting the gastrointestinal (GI) tract.

The researchers found that NSAIDs are effective in staving off colorectal cancers and may reduce the risk of stomach cancer.

More long-term research is needed to find and confirm the benefits for other cancers affecting the GI tract.

"Talk to your pharmacist about the pros and cons of aspirin therapy."

The study was conducted by three researchers from The University of Texas MD Anderson’s Department of Gastrointestinal Medical Oncology Cancer Center in Houston, Texas, led by Ibrahim Halil Sahin, MD.

The team reviewed recent research to assess the latest evidence on aspirin and NSAIDs preventing and treating GI cancers — including esophageal, gastric (stomach), pancreatic, colorectal cancer, and hepatocellular carcinoma (liver cancer).

The authors offered some perspective on GI cancers in the article introduction. Colorectal and stomach cancer are the most common cancers that affect the gastrointestinal tract, which is the system involved with food digestion. But of all GI malignancies, screening is available only for colorectal cancer.

Because these diseases are diagnosed at a relatively late stage, survival rates for esophageal, pancreatic, stomach and liver cancers are generally not very high.

So any medications that can prevent these cancers — so-called chemopreventive drugs — are of considerable interest.

Inflammation is common in the GI system due to an enzyme called COX-2 that is often seen in the GI tract. And high levels of COX-2 increase the risk of many GI cancers. NSAIDs and COX-2 inhibitors are well-known for their ability to block inflammation.

Over-the-counter NSAIDs include aspirin (brand names Bayer, Bufferin, Ecotrin, in Excedrin), ibuprofen (Advil, Motrin), and naproxen (Aleve). Prescription strength NSAIDs include COX inhibitors such as Celebrex.

After reviewing the literature, the research team found inconsistent results on the impact of NSAIDs on the development of esophageal cancer. Some studies have suggested that the medicines help to keep Barrett’s esophagus, a precursor to esophageal cancer, from developing into tumors. Other studies have found no benefits. Because of the inconsistency, the study researchers suggested that larger, multi-center trials are needed to study the NSAID benefits on esophageal cancer.

The latest research suggested that “...NSAID use is associated with a substantially decreased risk of gastric cancer,” the authors wrote. They caution that additional observational studies and randomized trials are needed to confirm this benefit.

The results of studies looking at aspirin and NSAID use in preventing pancreatic cancer have been mixed. COX inhibitors may have a limited impact in treating the disease, the authors concluded while suggesting the need for further study.

Preclinical trials have found that NSAIDs may have a chemopreventive effect on liver cancer, while other epidemiological studies looking at the origin of the disease have been inconsistent.

The benefit in colorectal cancer has been fairly well established. “Overall, observational epidemiological studies and clinical trials strongly suggest that NSAIDs and aspirin in particular, have a preventative effect against the development and progression of colorectal cancer.”

This review article was published September 7 as an Article in Press in Cancer Letters.

No conflicts of interest were reported.

Review Date: 
September 15, 2013