Distinct effects of anti-inflammatory and anti-thrombotic drugs on cancer characteristics at diagnosis

Abstract

Background: A previous study showed that regular use of low-dose aspirin was associated with smaller tumour size and fewer metastases for colorectal and lung cancer. We aim to explain these distinct effects in terms of the anti-inflammatory and anti-thrombotic properties of aspirin.

Methods: From the Swedish Cancer Register, we identified patients diagnosed with colorectal and lung cancers between 1st October 2006 and 31st December 2009; each cancer was assessed in terms of tumour size/extent (T), lymph-node (N) and metastatic (M) status. Linkage with the Swedish Prescribed Drug Register was performed to obtain information on the use of low-dose aspirin, anti-inflammatory and anti-thrombotic drugs prior to cancer diagnosis.

Results: We identified 14,743 individuals with colorectal cancer and 5888 with lung cancer. For low-dose aspirin users we observed a statistically significant association with smaller tumour size and fewer metastases. For both cancers, the use of non-aspirin anti-inflammatory drugs was associated with smaller tumour size in all categories T2-T4 odds ratio (OR = 0.76, 95% confidence interval (CI) 0.63-0.92 for T2 versus T1 in colorectal cancer), but not with metastatic status (OR = 0.94, 95% CI 0.84-1.06 in colorectal cancer). In contrast, anti-thrombotic drug use was associated with fewer metastases, but not with tumour categories T2 and T3.

Conclusions: The results suggest that the use of anti-inflammatories is associated with tumour-growth inhibition at the primary site, while the use of anti-thrombotics is associated with restriction of cancer-cell metastasising capability. These have clinical implications on the potential use of these drugs for chemoprevention or chemotherapy.

Keywords: Anti-platelet; COX inhibitors; Carcinogenesis; Chemoprevention; Chemotherapy; Drug prescription registry; Metastasis.