Taking aspirin and anti-acid reflux medication prevents oesophageal cancer in high risk patients

Taking an anti-acid reflux medication together with a low dose of aspirin can prevent oesophageal cancer in people with a high risk of the disease, shows a Cancer Research UK funded study presented at ASCO, today (Monday, 12.30pm BST; 6.30am CT).

In the AspECT trial people were given a high dose of the Proton Pump Inhibitor (PPI) esomeprazole, which reduces the production of stomach acid, alongside a low dose of aspirin. The patients being treated had a condition called Barrett’s oesophagus that increases the risk of oesophageal cancer.

They found that people who took this combination for at least seven years were 20% less likely to develop oesophageal cancer than if they had been untreated, a result that was much better than the researchers expected.

Barrett’s oesophagus is a condition that is partly genetically predisposed and aggravated by reflux of acid into the oesophagus. Patients with Barrett’s are at around a fifty times greater risk of oesophageal cancer, though only 2% go on to develop the disease. Of those who do develop cancer, only 12% will survive for 10 years or more.

Professor Janusz Jankowski, lead author and Cancer Research UK funded researcher at the Royal College of Surgeons, Ireland and the National Institute for Health and Care Excellence, UK, said: “Our results are very exciting. Oesophageal cancer is hard to diagnose and hard to treat. So, we’re pleased that such a cheap and well-established medicine can prevent and/or delay development of cancer for these patients. Our hope is that this may also offer an opportunity to prevent oesophageal cancer in wider populations.”

The AspECT trial involved over two and a half thousand patients with Barrett’s oesophagus, randomly assigned to four groups. Each group took different doses of the PPI esomeprazole, with and without low dose aspirin.

The researchers then followed the four groups of patients for an average of 8.9 years. They found the most effective combination was high dose esomeprazole with low dose aspirin, followed by high dose esomeprazole.

Dr Justine Alford, from Cancer Research UK, said: “The Cancer Research UK funded trial shows that combining a stomach acid-reducing medicine – a PPI – with aspirin has potential to delay or maybe even prevent oesophageal cancer in people who have Barrett’s oesophagus, a condition present in at least 2% of the population caused by chronic acid reflux that raises the risk of developing this cancer. It’s important to remember that even though you can buy it over the counter aspirin can have serious side effects like internal bleeding, so anyone thinking of taking regular aspirin should chat to their doctor first.

“Oesophageal cancer can be hard to diagnose at an early stage and so can be hard to treat; there hasn’t been a significant improvement in survival for decades. Cancer Research UK has therefore identified oesophageal cancer as a cancer of unmet need, along with brain tumours, lung cancer, and pancreatic cancer. We will increase our investment in researching these cancers two- to threefold over the next five years.”