Aspirin and Targeting COX-2 in Colorectal Cancer

Clinical Pearls

Charles S. Fuchs, MD, MPH, director, Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, on the use of aspirin and targeting COX-2 in colorectal cancer.

• Level 1 evidence exists for aspirin as a preventative agent against colorectal polyps or cancer
• In several observational studies, patients who have started chemotherapy for CRC and reported aspirin use had significant improvement in cancer-free survival
• It is widely believed that one target for aspirin is cyclooxygenase-2 (COX-2), a marker that affects an increased proliferation in cancer cells
• Aspirin has demonstrated efficacy in patients with COX-2-overexpressing colon cancer
• There is a need for randomized trials in this space like CALGB 80702, in which patients who have been resected for stage 3 colon cancer will receive chemotherapy and will be randomized to a COX-2 inhibitor (not aspirin)