In 2020, lung cancer was the leading cause of cancer death, accounting for 18% of all cancer deaths. Lung cancer also represents 11.4% of all cancer diagnoses, with non–small-cell lung cancer (NSCLC) accounting for the majority of cases of lung cancer. Approximately 65% of patients with NSCLC are initially diagnosed with locally advanced or metastatic disease that conveys a poor prognosis despite aggressive treatment. These poor patient outcomes demonstrate an ongoing need to develop effective treatments for NSCLC.
Recently, there has been renewed interest in repurposing aspirin for cancer treatment. Aspirin inhibits cyclooxygenase enzymes, which promote carcinogenesis via synthesis of prostaglandin. Aspirin also upregulates tumor-suppression genes, inhibits NF-kB activation, and may induce apoptosis, suppress angiogenesis, and inhibit cancer cell proliferation. A study of 700 patients with colorectal cancer demonstrated that the use of aspirin was associated with reducing the risk of developing cancer. Further epidemiologic studies have established an inverse association between aspirin use and the risk of cancer development. However, other clinical trials have demonstrated no association, and 1 study in elderly patients demonstrated an increased risk of cancer-related mortality. Similarly, in aspirin-use studies of patients with NSCLC, results have been unclear.
To help clarify if aspirin use benefits those with NSCLC, a population-based retrospective cohort study of 4979 adult patients between the ages of 18 and 90 years with inoperable NSCLC was performed and the results were published in BMC Cancer. This patient cohort used aspirin at the time of diagnosis and for >28 daily doses after diagnosis. Exclusion criteria included patients who received pulmonary surgery, patients treated with etoposide, and those patients with coexisting malignancies. The matched cohort group (n = 4932) did not use aspirin. The study’s primary objective was overall survival with a median follow-up time of 1.73 years for the aspirin cohort and 1.22 years for the non–aspirin-use cohort. For the aspirin cohort, the median time of aspirin use was 0.47 years with a mean of 0.88 ± 1.12 years. Aspirin users were more likely to be male, have comorbidities, and to be older. Aspirin users had a significant survival benefit, with a median overall survival of 1.73 years compared with 1.30 years for the non-aspirin users. This study did have several limitations. Information about patient histology and TNM staging was not available. Body mass index, smoking history, family history, exposure to environmental toxins, and details on chemotherapy and radiotherapy were also not available for analysis.
This study suggests that aspirin use in patients with inoperable NSCLC is associated with increased survival, but further research is necessary to confirm these findings.
Chuang MC, Yang YH, Hsieh MJ, et al. The association of aspirin use with overall survival of patients with inoperable non-small cell lung cancer: a retrospective study. BMC Cancer. 2021;21:1257.
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