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Chemoprevention in Lynch syndrome

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Abstract

CAPP1 tested aspirin 600 mg/day and/or resistant starch 30 g/day in 200 adolescent FAP carriers. Aspirin treatment resulted in a non-significant reduction in polyp number and a significant reduction in polyp size among patients treated with aspirin for more than 1 year. CAPP2 RCT used the same interventions in 937 Lynch syndrome patients, the first RCT to have cancer prevention as the primary endpoint. Aspirin did not reduce the risk of colorectal neoplasia in a mean treatment period of 29 months but double blind post intervention follow-up has revealed 48 participants developed 53 CRCs. Per protocol analysis showed 63 % fewer colon cancers with aspirin (p = 0.008) apparent from 4 years, with a similar effect on other LS cancers. Resistant starch was not beneficial at long term followup. CAPP3 will involve a double blind dose non-inferiority trial comparing 100, 300 or 600 mg daily in 3,000 gene carriers. We can now recommend aspirin in people at high risk of colorectal cancer.

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Authors and Affiliations

  1. Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK

    John Burn

  2. Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK

    John C. Mathers

  3. Leeds Institute of Molecular Medicine, Leeds University, Leeds, UK

    D. Tim Bishop

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  1. John Burn
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  2. John C. Mathers
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  3. D. Tim Bishop
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Correspondence to John Burn.

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Burn, J., Mathers, J.C. & Bishop, D.T. Chemoprevention in Lynch syndrome. Familial Cancer 12, 707–718 (2013). https://doi.org/10.1007/s10689-013-9650-y

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