Investigators uncovered critical issues related to health equity and aging that may have broad implications for cancer trials among breast cancer survivors receiving aspirin, according to a recent study published by Mandelblatt et al in JAMA.
Study Methods and Results
In the recent study, the investigators analyzed the findings from the phase III Alliance trial—which was launched after researchers noted that breast cancer survivors receiving aspirin and participating in a separate clinical trial for cardiovascular disease experienced greater survival outcomes. To confirm this observation, the researchers randomly assigned participants with nonmetastatic, high-risk breast cancer to receive either 300 mg of aspirin or placebo daily. However, the trial was suspended at the first interim safety analysis because the results indicated that aspirin did not decrease the risk of cancer recurrence or improve survival.
The investigators noted that despite efforts to include various groups in the trial, certain subgroups such as racial minorities and patients with high exposure to systemic racism may not have been adequately represented. They emphasized that these patient subgroups may benefit from aspirin.
“Some [patients] from these groups may experience chronic life stressors that affect inflammation, accelerate biological aging, and contribute to disparities in cancer risk, recurrence, and mortality,” the study authors hypothesized.
Conclusions
“[The Alliance trial] raises the question of whether aspirin's lack of benefit could be partly explained by variations in biological age, including heterogeneity in immune and platelet function, inflammatory responses, and host-tumor microenvironment interactions. Thus, careful consideration of the intersectionality of aging, cancer, and disparities will be critical in designing future oncology and other disease trials to advance health equity,” the study authors underscored.
The investigators suggested that physicians may experience challenges in integrating new findings into routine practice because the results demonstrated a lack of intervention efficacy.
Despite the fairly definitive negative result for the use of aspirin to improve invasive disease–free survival among breast cancer survivors, “oncology and primary care providers may still consider discussing with each other and their patients the potential benefits and harms of aspirin used for other reasons,” the study authors concluded.
Disclosure: The research in this study was supported in part by grants from the National Cancer Institute and National Institute on Aging at the National Institutes of Health as well as Pfizer and Cantex pharmaceuticals. For full disclosures of the study authors, visit jamanetwork.com.
