Can Aspirin Prolong Survival in Patients With NSCLC?

According to a new study from Taiwan, taking aspirin was associated with longer overall survival in people with unresectable non-small cell lung cancer (NSCLC).

The analysis, published online on November 22nd in BMC Cancer, adds another data point to a small and inconsistent evidence base.

“Although future prospective randomized clinical trials are required, aspirin may be considered as an add-on treatment for inoperable NSCLC patients,” write Ming-Szu Hung, MD, of Chang Gung University, Taoyuan City, and colleagues.

The current literature suggests that the over-the-counter drugs may help fight various types of cancer, including lung cancer, but the various study results do not always agree. For lung cancer survival in particular, some observational studies have found increased survival rates in aspirin users while others have not.

To bring clarity to the literature, Hung’s team examined data from Taiwan’s National Health Insurance Research Database on more than 38,000 patients diagnosed with NSCLC between 2000 and 2012, of whom nearly 5000 were taking aspirin at diagnosis.

The researchers found that aspirin users survived a median of 1.73 years, compared with 1.30 years for non-users. In the time-varying covariate analysis, taking the drug was associated with longer overall survival (hazard ratio [HR], 0.83; 95% CI, 0.80-0.86). This finding was confirmed in a propensity score analysis of 4932 paired pairs (HR 0.79; 95% CI 0.75-0.83).

“These results warrant further randomized clinical trials to assess the real role of aspirin in the treatment of NSCLC patients,” the researchers conclude.

But Úna McMenamin, PhD, cancer epidemiologist at Queen’s University Belfast in Ireland, was not convinced by the methods of the study.

While praising the size and use of population-based health registries, she expressed concern about the potential for reverse causation “as it is unclear whether the authors lagged aspirin exposure in the cohort of lung cancer patients”.

There is evidence that popular drugs like aspirin can be discontinued by patients who are believed to be near the end of their lives, McMenamin told Medscape Medical News. When not included in the statistical analysis, aspirin “may appear to be linked to a reduced risk of death when in fact unrelated”.

Previous studies of aspirin use in lung cancer patients that included delay, such as one conducted by McMenamin and colleagues in 2015, have found no evidence of a protective effect.

For this reason, according to McMenamin, “additional population-based studies in different population groups are needed to investigate the relationship between aspirin use and survival outcomes in lung cancer patients to determine whether randomized controlled trials in this group of patients are warranted.”

She also noted that “any potential benefits of aspirin in lung cancer patients must be weighed against known side effects associated with prolonged use of aspirin, such as gastrointestinal bleeding.”

Hung did not respond to requests for comment.

The study had no funding and the researchers did not report any conflicts of interest.

BMC cancer. Published online 22 November 2021. Full text

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