Patient case: 73-year-old female with breast cancer; genetic feature: CDKN2A

Clinical trial: Aspirin in Preventing Colorectal Cancer in Patients With Colorectal Adenoma

Summary: This randomized phase IIa trial studies how well aspirin works in preventing colorectal cancer in patients with colorectal adenoma. Aspirin may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth

Detailed description: PRIMARY OBJECTIVES:
  I. To test for the equivalency of the two aspirin schedules.
  SECONDARY OBJECTIVES:
  I. To evaluate the effects of aspirin treatments on the ratio of cell proliferation (Ki-67)/apoptosis (TUNEL) in rectal biopsies.
  II. To evaluate the effects of aspirin treatments on the ratio of cell proliferation (Ki-67)/necroptosis (MLKL) in rectal biopsies.
  III. To evaluate the effects of aspirin treatments on fecal occult blood test (measures of adverse events) as measured by stool samples.
  IV. To evaluate the effects of aspirin treatments on methylation biomarkers in genes (i.e. CDKN2A [cell cycle regulation], MGMT [DNA repair], DAPK1 [apoptosis], CDH1 [cell invasion], WNT16 [Wnt pathway] and RASSF1 [RAS signaling]) involved in colorectal carcinogenesis, as measured in rectal biopsies.
  V. To evaluate the effects of aspirin treatments on colorectal mucosal nanoscale cellular structural changes measured by PWS (partial wave spectroscopy) obtained through rectal brushings.
  VI. To evaluate the effects of aspirin treatments on abundance of E. coli and Fusobacterium in rectal swabs.
  VII. To evaluate if the effects of aspirin arms may be modified by dietary intake of calcium as measured by the Food Frequency Questionnaire (FFQ).
  OUTLINE: Patients are randomized to 1 of 3 arms.
  ARM I: Patients receive aspirin orally (PO) daily for 12 weeks.
  ARM II: Patients receive aspirin PO daily at weeks 1-3 and 7-9 and placebo PO daily at weeks 4-6 and 10-12.
  ARM III: Patients receive placebo PO daily for 12 weeks.
  After completion of study, patients are followed up at 6 months.

Eligibility: Inclusion Criteria:
  -  Diagnosis of colorectal adenoma of any grade
  -  Eastern Cooperative Oncology Group (ECOG) performance status =< 1 (Karnofsky >= 70%)
  -  Leukocytes >= 3,000/microliter
  -  Absolute neutrophil count >= 1,500/microliter
  -  Platelets >= 150,000/microliter
  -  Total bilirubin =< 1.5 x institutional upper limit of normal (ULN)
  -  Aspartate aminotransferases (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 1.5 x institutional ULN
  -  Creatinine within normal institutional limits
  -  Blood hemoglobin >= 12.0 g/dL
  -  Alkaline phosphatase =< 1.5 x institutional ULN
  -  Blood urea nitrogen (BUN) =< 40 mg/dL
  -  Epidermal growth factor receptor (eGFR) >= 45 mL/min
  -  Negative fecal occult blood test
  -  Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately
  -  Ability to understand and the willingness to sign a written informed consent document
  Exclusion Criteria:
  -  Current or planned use during the study intervention of the following:
  -  Aspirin, other nonsteroidal antiinflammatory drugs (NSAIDs), or COX-2 inhibitors
  -  Anticoagulants, antiplatelet agents, or corticosteroids
  -  Gingko
  -  Ethanol consumption > 1 standard drinks/day for women, or > 2 standard drinks/day for men
  -  Methotrexate (MTX)
  -  Study participants will be instructed to use Tylenol or some other non-excluded agent to treat common ailments (i.e. headache/minor aches and pains)
  -  History of
  -  Any invasive malignancy within the past 2 years, with the exception of non-melanoma skin cancer
  -  Chronic renal diseases or liver cirrhosis
  -  Diseases such as anemia, peptic ulcer, gastrointestinal bleeding, active colitis and inflammatory bowel disease
  -  Hemorrhagic stroke or uncontrolled hypertension
  -  Participants may not be receiving any other investigational agents
  -  History of allergic reactions or intolerance attributed to aspirin or compounds of similar chemical or biologic composition
  -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness that would limit compliance with study requirements
  -  Women who are pregnant or breastfeeding; breastfeeding should be discontinued if the mother is treated with aspirin

Relevance to patient case: not relevant