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Two years of high-dose aspirin cut bowel cancers in people with Lynch syndrome by about a third over the following decade. It is the only drug shown in a randomised trial to prevent this cancer.
In the double-blind CAPP2 trial, Burn, Sheth, Elliott and colleagues randomised 861 people with Lynch syndrome from 43 international centres to 600 mg of aspirin daily or placebo; 937 eligible participants of mean age 45 commenced treatment. Cancer outcomes were monitored for at least ten years from recruitment, with English, Finnish and Welsh participants followed for up to 20 years through registries. The primary endpoint was development of colorectal cancer, analysed by intention to treat and per protocol.
Participants were followed for a mean of ten years, approximating 8,500 person-years. Adverse events during the intervention phase were similar between groups.
Chemoprevention in a defined high-risk group is possible, and aspirin is now offered to Lynch syndrome carriers in UK practice; the CaPP3 dose-finding study asks whether a much smaller dose does the same.
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