Aspirin and colon cancer
Aspirin is a well-known oral medication widely used as an analgesic and antipyretic drug. In addition, it has been applied to prevent and treat cancer. The classic anti-cancer mechanism of aspirin is to inhibit the activity and inflammation of COX enzymes. In addition, aspirin could inhibit cancer progression by reducing glycolytic levels in tumors. Salicylate is the metabolite of aspirin that could activate AMPK (5'adenosine monophosphate-activated protein kinase) signaling, which further inhibits mTOR signaling and suppresses energy metabolism, including glycolysis. It has been reported that aspirin under directly regulates the level of ENO1, PDK1 and PFKFB3 to attenuate glycolysis and tumor progression. In CRC, several preclinical studies have explored the potential antitumor mechanisms of aspirin.
Clinical studies have demonstrated the potent effect of aspirin in preventing CRC. A double-blind, randomized, placebo-controlled clinical trial of Asian patients with colorectal adenomas and adenocarcinomas indicated that aspirin use (100 mg/day for 2 years) significantly reduced colorectal cancer recurrence (OR = 0.6). Similarly, another clinical trial revealed that daily aspirin use in patients with CRC can reduce adenoma recurrence. Long-term intake of 600 mg of aspirin daily also substantially inhibited cancer occurrence in patients with Lynch syndrome.
However, some studies showed no significant effect of aspirin on the treatment of patients with CRC, pointing to genetic differences in patients, thus highlighting that the application of aspirin requires precise identification of individuals.
To date, a total of 41 clinical trials using aspirin in CRC are listed at https://www.clinicaltrials.gov/, and most clinical trials focus on identifying the effect of aspirin in preventing CRC and the risk category most likely to benefit from aspirin use.
