Aspirin Outdoes Celecoxib in Cancer Avoidance Model

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From Medscape http://www.medscape.com/viewarticle/482785

Aspirin Outdoes Celecoxib in Cancer Avoidance Model

By David Douglas

NEW YORK (Reuters Health) Jul 07 - Aspirin is not only less expensive than the cyclooxygenase-2 (COX-2) inhibitor celecoxib, but appears to be a better choice for colorectal cancer chemoprevention in healthy subjects, according to findings of a computer-based simulation featured in the July 1st issue of Cancer.

"Our analysis suggests that average-risk individuals contemplating COX-2 inhibitor therapy for colon cancer prevention should keep in the mind the added cardiac benefit of aspirin," lead investigator Dr. Chin Hur told Reuters Health.

Dr. Hur, of Massachusetts General Hospital, Boston, and colleagues note that there is a growing trend for healthy people to use aspirin for chemoprevention of both cardiovascular and oncological diseases. COX-2 inhibitors may also be protective against colorectal cancer, but may not provide cardiovascular benefits.

To investigate, the researchers constructed a computer model involving simulated cohorts of healthy men aged 50 years. These hypothetical subjects took either 325 mg of enteric-coated aspirin daily or celecoxib 400 mg twice daily.

Both agents were assumed to have an equivalent effect on colorectal cancer risk, but data from the literature and other sources were used to influence the risk of complications and other events.

Over a 10-year period, compared to celecoxib, use of aspirin cost $23,000 less and resulted in an increase of 0.03 quality-adjusted life years.

The celecoxib group had 3.877% more complications and 0.17% more deaths. This amounted to 1 complication for every 26 celecoxib patients and 1 death for every 588 patients.

The researchers concede that further studies are needed to establish how effective these agents are in preventing tumors. However, they conclude that the results suggest that in the studied circumstances "aspirin is the clear choice."

Cancer 2004;101:189-197.