Aspirin can be used to prevent relapse in colorectal cancer after initial treatment. When to use aspirin for treatment of Stage 2 and Stage 3 colorectal cancer? PIK3C mutation and treatment of colon cancer with aspirin. Colon cancer aspirin therapy. Dr. Anton Titov, MD. Cox-1 and COX-2 inhibitors to treat colon cancer and prevent recurrence of colorectal cancer after treatment. Dr. David J. Kerr, MD. Leading colorectal cancer expert from Oxford discusses aspirin use in therapy of colon cancer. Aspirin helps to prevent colon cancer but aspirin can also treat colon cancer. Aspirin affects environment around colorectal cancer tumor. Dr. Anton Titov, MD. Clinical trial to use aspirin to prevent relapse of stage 2 and stage 3 colorectal cancer. PIK3C mutation and aspirin treatment of colon cancer. Colorectal cancer aspirin treatment options. Advanced colon cancer targeted chemotherapy combined with aspirin. Second opinion confirms that colorectal cancer diagnosis is correct and complete. Second opinion also confirms that cure of colon cancer is possible even in advanced colon cancer. Dr. David J. Kerr, MD. Best treatment for advanced colon cancer with metastatic lesions might include low dose aspirin. Second opinion helps to choose precision medicine and the best targeted chemotherapy plus aspirin for treatment of colorectal cancer. Get second opinion on advanced colorectal cancer and be confident that your precision medicine cancer treatment is the best. Dr. Anton Titov, MD. Best colorectal cancer treatment center for personalized medicine. Video interview with leading expert in metastatic colorectal cancer treatment from Oxford. Colon cancer aspirin therapy. Aspirin prevents recurrence of colon cancer. Dr. Anton Titov, MD. Use of non-steroidal anti inflammatory agents (aspirin) in colorectal cancer treatment and prevention is one of your interests. Experience with selective COX-2 inhibitors has been mixed. Dr. Anton Titov, MD. You wrote in New England Journal of Medicine about the risks and benefits of COX-2 inhibitors for colon cancer therapy. It was before Vioxx was withdrawn from the market. Dr. Anton Titov, MD. What is your current thinking about the use of non-steroidal anti-inflammatory agents in treatment of colon cancer and rectal cancer? How to use aspirin in colon cancer? Dr. David Kerr, MD (Colon cancer oncologist, Oxford). As we've discussed I spend a large amount of time working with colleagues in Oxford. We study the molecular genetics of colorectal cancer cells within the tumor. But over the past 4 or 5 years I have realized this. Microenvironment of the tumor is as important for treatment result as the genetics of the cancer itself. Sometimes we can influence the degree of inflammation within a colon cancer tumor. Then we may be able to modify colorectal cancer tumor's clinical behavior. Aspirin is an inhibitor of COX-1 and COX-2 enzymes. Rofecoxib (Vioxx) and celecoxib (Celebrex) are selective COX-2 inhibitors. Dr. David J. Kerr, MD. We were very interested to ask this question in a clinical trial. Would aspirin or COX-2 inhibitor reduce the recurrence of colorectal cancer? First, the surgical resection of colon cancer tumor and after adjuvant chemotherapy was done. In our large clinical trial Vioxx (rofecoxib) was withdrawn because of worries about cardiotoxicity of rofecoxib. This was done prematurely, in my opinion. For colorectal cancer patients risks of cardiotoxicity from Vioxx or Celebrex are relatively trivial. We could not recruit enough patients into that clinical trial. Dr. Anton Titov, MD. This situation is analogous to what we saw in multiple sclerosis with Tysabri. Very serious side effect was discovered. But side effects were managed successfully, considering the seriousness of disease. Dr. Anton Titov, MD. How to interpret the risks of medication for different patients? Side effects risks for general population or in cancer treatment have different meaniing. Dr. David Kerr, MD (Colon cancer oncologist, Oxford). I absolutely agree with this statement. COX-2 inhibitors (Vioxx, Celebrex) were developed for arthritis patients. These are non-steroidal anti-inflammatory medications. This is a very different patient profile than colon cancer patients. They are at risk of cancer returning. Risk - benefit ratio for cancer patients is very different than that for arthritis patients. Colon cancer patients are more likely to take greater risks with the treatment. Dr. David J. Kerr, MD. Patients with sore knee or sprained ankle will take less risk of side effects. Dr. Anton Titov, MD. There is a lot of good epidemiological and observation data. It suggests that aspirin can prevent colon cancer from developing. In those patients who have developed colorectal cancer, aspirin can reduce the risk of cancer returning. There is a large clinical trial in the UK that looks at adjuvant use of aspirin for Stage 2 and Stage 3 colorectal cancer treatment. We are planning a clinical trial in Oxford that will use precision medicine. We have done colorectal cancer treatment work in Oxford. Dr. David J. Kerr, MD. We repeated excellent work by our colleagues at Harvard. This work shows that benefits of aspirin in colon cancer may be confined to those patients who have a mutation in a gene called PIK3C. We repeated this work and showed exactly the same result as our Harvard colleagues. We are proposing a clinical trial for colorectal cancer patients who have a mutation in PIK3C gene. We will randomize colon cancer patients to receive aspirin or placebo prospectively. We would like to demonstrate if in some patients, aspirin can prevent relapse and recurrence of colon cancer. Expected effect is in 15% of colon cancer patients. Dr. Anton Titov, MD. What doses of aspirin are you using in this clinical trial? Because for prevention of cardiovascular events there are very different dosage of aspirin. They are used in various clinical trials. Dr. David Kerr, MD (Colon cancer oncologist, Oxford). We are using low dose aspirin, 100 mg per day. But you are absolutely correct. There is a controversy about aspirin dosing. We need more money, more patients and more time for clinical trial. Then we would probably ask this question. Dr. Anton Titov, MD. What is the best aspirin dose in cancer recurrence prevention? I would like to have three study arms to see if there was a dose effect. This is my understanding of the clinical evidence and molecular pharmacology of aspirin. I don't think that there is dose effect relationship between aspirin dose and its effects. Dr. David J. Kerr, MD. We have to choose one dose. Then we would choose a low-dose aspirin (100 mg per day). But there is a benefit to look at different doses of aspirin in colon cancer treatment. I agree with that. Dr. Anton Titov, MD. Aspirin is a medication that is not expensive. Aspirin is widely available. Aspirin can probably make even a small difference in the recurrence rate of colon cancer. Then it will mean a lot for colon cancer patients. Dr. David Kerr, MD (Colon cancer oncologist, Oxford). I absolutely agree. We say it's "teaching old medications new tricks". Knowing molecular biology of colon cancer is crucial. Selecting patients for appropriate colon cancer therapy is then possible. Dr. David J. Kerr, MD. We will have to see if we can amplify the potential of using aspirin to treat colon cancer. Dr. Anton Titov, MD. That would be a great story. I hope we can demonstrate the positive effects of aspirin on colon cancer recurrence. Colon cancer aspirin therapy can be effective. Aspirin changes microenvironment of tumor. Leading colon cancer expert (Oxford) on aspirin cancer therapy. Aspirin can be used to prevent relapse in colorectal cancer after initial treatment. When to use aspirin for Stage 2 and Stage 3 colorectal cancer adjuvant treatment? PIK3C mutation and treatment of colon cancer with aspirin. Leading colorectal cancer expert from Oxford discusses aspirin use in therapy of colon cancer.