Biliary tract cancer (BTC) is a rare, difficult-to-treat gastrointestinal (GI) cancer that typically presents at late stages and has a poor prognosis. Thoughts are that Aspirin has an anticancer effect due to its anti-inflammatory and anticlotting activities. An analysis recently published in JAMA Oncology evaluated the impact of prolonged aspirin use in 2,934 patients with BTC diagnosed between 1990 and 2017 in the United Kingdom. Patients with gallbladder cancer, cholangiocarcinoma, ampulla of Vater cancer (AVC), and overlapping lesions of the biliary tract were included in this study.
Among all patients included in this analysis, the median overall survival (OS) was 5.8 months, and 82% of patients had died at the time of analysis. A total of 21% of patients were aspirin users, with 9% using aspirin prior to diagnosis and 12% initiating aspirin after diagnosis. The majority of patients received a dose of 75 mg. Aspirin use was associated with decreased risk of death compared to patients who did not use aspirin, a benefit that was seen across all BTC subtypes (gall bladder cancer HR 0.63; cholangiocarcinoma HR 0.71; AVC HR 0.44; overlapping lesions HR 0.68). Patients who initiated aspirin after diagnosis had the greatest benefit seen, compared to those who used aspirin prior to diagnosis.
The investigators concluded that aspirin use is associated with decreased risk of death in patients with BTC that is similar to the benefit observed with current standard of care therapy. However, the precise mechanism by which aspirin functions is not yet clear. Further prospective studies are necessary to identify the long-term impact of aspirin use among patients with BTCs.
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