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Aspirin and PPI ‘prevents oesophageal cancer in high risk patients’

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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, according to a UK trial.

The AspECT trial saw patients given a high dose of the proton pump inhibitor esomeprazole, which reduces the production of stomach acid, alongside a low dose of aspirin.

“We’re pleased that such a cheap and well-established medicine can prevent or delay cancer development”

Janusz Jankowski

The patients involved had Barrett’s oesophagus, a condition that increases the risk of oesophageal cancer. Barrett’s oesophagus is partly genetically predisposed and aggravated by acid reflux.

Those with the condition are at around a fifty times greater risk of oesophageal cancer, though only 2% go on to develop it. Of those who do develop cancer, only 12% will survive for 10 years or more.

The researchers found those who took the drug combination for at least seven years were 20% less likely to develop oesophageal cancer than if they had been untreated.

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.

“There hasn’t been a significant improvement in survival for decades”

Justine Alford

They found the most effective combination was high dose esomeprazole with low dose aspirin, followed by high dose esomeprazole.

The trial, funded by Cancer Research UK, was presented today at the American Society of Clinical Oncology’s (ASCO) annual meeting in Chicago.

Lead study author Professor Janusz Jankowski, from the University of Central Lancashire, said: “Our results are very exciting.

“Oesophageal cancer is hard to diagnose and hard to treat,” he said. “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,” he added.

Dr Justine Alford, from Cancer Research UK, said: “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.”

As a result, she said the charity had 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,” she added.

There are around 9,000 new oesophageal cancer cases in the UK every year and around 7,900 oesophageal cancer deaths in the UK every year.

It is the 13th most common cancer in the UK, accounting for 3% of all new cancer cases in 2015.

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