Investigators have found that only a minority of patients with Lynch syndrome may be receiving aspirin as chemopreventive therapy, according to new findings presented by Singhal et al at the 2024 ASCO Gastrointestinal Cancers Symposium (Abstract 19).
Background
“[Patients] with Lynch syndrome are at increased risk for colon cancer over their entire life span, and even though we know that increasing the colonoscopy screening [frequency] can help lower the risk of developing cancer, it doesn’t prevent cancer altogether,” stressed senior study author Michael J. Hall, MD, MS, Chair of the Department of Clinical Genetics and Director of the Gastrointestinal Risk Assessment Program at Fox Chase Cancer Center. “For these [patients] that we know have such high risk, additional adjunctive therapies are attractive,” he added.
Aspirin is known to have preventive effects in patients at average risk of colon cancer. Previous studies—such as the CAPP2 trial—have demonstrated that receiving aspirin for at least 2 years can help decrease the risk of developing colon cancer by about 40% in patients with Lynch syndrome, the most common type of hereditary colorectal cancer. Further, risk reduction following aspirin use may persist for up to 10 years.
“[Patients] in general are not as interested in preventive approaches to medicine. We had noted anecdotally that patients did not seem to be using aspirin as a chemopreventive,” Dr. Hall emphasized.
Study Methods and Results
In the PREVENTLynch study, the investigators used the Fox Chase Cancer Center risk registry to survey 296 patients—the majority of whom had completed intensive colonoscopy surveillance and about two-thirds of whom completed annual screening—regarding their perceptions of aspirin chemoprevention. The investigators discovered that only about one-quarter of the respondents reported taking aspirin and about one-fourth of them were receiving the drug for an unrelated cardiac indication.
They identified no statistically significant differences among the patients who did and did not receive aspirin based on age, race, and underlying Lynch syndrome genetic subtype. Notably, aspirin was perceived to be convenient both among patients receiving it and those not receiving it. Compared with those who did not receive aspirin, the patients who chose to receive aspirin had greater concerns about its side effects as well as the prevention reassurance of the protective benefits of aspirin.
Conclusions
The investigators commented that the new findings may be critical to help researchers developing novel preventive strategies for colon cancer better understand the barriers that might limit their research.
“Even in this high-risk population, engagement in a chemoprevention choice that we know has been proven in a trial to be beneficial was not great,” Dr. Hall underscored. “Part of what we work to do is identify what is most attractive to patients. Even if the prevention method has a smaller benefit, if it is attractive and more [patients] engage with it, the more effective it is. We need to not only think about exciting new interventions, but about whether or not they are approachable for patients,” he concluded.
Disclosure: For full disclosures of the study authors, visit meetings.asco.org.
