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News

Aspirin or resistant starch in colorectal neoplasia in the Lynch syndrome

This week’s New England Journal of Medicine examines the effect of aspirin or resistant starch on colorectal neoplasia in the Lynch syndrome.

News image

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Observational and epidemiologic data indicate that the use of aspirin reduces the risk of colorectal neoplasia.

However, the effects of aspirin in the Lynch syndrome, including hereditary nonpolyposis colon cancer, are not known.

Resistant starch has been associated with an antineoplastic effect on the colon.

Dr John Burn and colleagues from the United Kingdom conducted a randomized, placebo-controlled trial, a two-by-two design to investigate the effects of aspirin.

At a dose of 600 mg per day, and resistant starch (Novelose), at a dose of 30 g per day, in reducing the risk of adenoma and carcinoma among persons with the Lynch syndrome.

The researchers found that among 1071 persons in 43 centers, 62 were ineligible to participate in the study, 72 did not enter the study, and 191 withdrew from the study.

Neoplasia developed in 19% of participants receiving aspirin
New England Journal of Medicine

These 3 categories were equally distributed across the study groups.

The team found over a mean period of 29 months, colonic adenoma or carcinoma developed in 141 participants.

Of 693 participants randomly assigned to receive aspirin or placebo, neoplasia developed in 19% of participants receiving aspirin and in those receiving placebo.

There were no significant differences between the 2 groups with respect to the development of advanced neoplasia.

Among the 727 participants receiving resistant starch or placebo, neoplasia developed in 19% of participants receiving starch, as compared with 18% receiving placebo.

Advanced adenomas and colorectal cancers were evenly distributed in the 2 groups.

The team noted that the prevalence of serious adverse events was low, and the events were evenly distributed.

Dr Burn’s team concluded, “The use of aspirin, resistant starch, or both for up to 4 years has no effect on the incidence of colorectal adenoma or carcinoma among carriers of the Lynch syndrome.” 

NEJM 2008: 359(24): 2567-78


16 December 2008

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