“While aspirin has been studied for colorectal cancer prevention, its modest benefit and bleeding risks limit its use. GLP-1 receptor agonists, now widely prescribed for diabetes and obesity, may offer a safer option for both metabolic control and cancer prevention. This study is important because it provides the first large-scale, real-world evidence comparing aspirin and GLP-1 receptor agonists directly,” said lead study author Colton Jones, MD, Hematology & Oncology Fellow, The University of Texas San Antonio.

This study looked at health data from TriNetX, a commercial database, and included 281,656 participants.

Half of them took a GLP-1, and half took aspirin.

The average age of participants in both groups was 58 years old, and most participants were female (69%).

Among the participants, 67% were White, 12% were Black, and 2.3% were Asian. 

Researchers looked at participants’ health records to see if colorectal cancer was diagnosed after starting either a GLP-1 or aspirin.

The median time over which the participants’ health was followed was about 6 years for the GLP-1 group and about 5 years for the aspirin group. 

• People who took GLP-1s were 36% less likely to get colorectal cancer than people who took aspirin.
• Of the participants whose health or family history put them at higher risk of developing colorectal cancer, people who took GLP-1s were nearly 42% less likely to get the disease than people who took aspirin.
• Across all participants:
  • Acute kidney injury, stomach ulcers, and gastrointestinal bleeding were less common in the GLP-1 group than in the aspirin group.
  • Diarrhea and abdominal pain were more common in the GLP-1 group than in the aspirin group.
  • Nausea and vomiting were about the same in both groups.
• The benefit for any one person was small: The statistics showed that more than 2,000 people would need to be treated with a GLP-1 for 1 person to have a lower risk of developing colorectal cancer.
  • But in a recent survey, 6% of adults were taking these medicines. That could mean as many as 20 million Americans are already using GLP-1 receptor agonists and many of them could have a reduced risk of developing colorectal cancer.
• GLP-1s reduced colorectal cancer risk in participants who began the medicine before age 45.
  • The drugs reduced colorectal cancer risk, regardless of whether or not participants had obesity or diabetes.
  • However, they did not reduce the risk of colorectal cancer in people who used tobacco or had atherosclerosis.
• As a whole, GLP-1s studied showed a reduced risk of colorectal cancer.
  • However, when studied individually, the effect of only semaglutide, liraglutide, and dulaglutide was significant.
  • Tirzapeptide and exenetide did not show the same significance in this study.

“GLP-1 receptor agonists may have benefits far beyond the waistline. These findings show that they may be an important part of cancer prevention treatment strategies as well. The preventive benefits of aspirin, nonsteroidal anti-inflammatory drugs, and statins in the development of colorectal cancer have been investigated for years. This real-world study suggests that the GLP-1 receptor agonists may have an exciting role in this area. Further research is certainly a priority to understand the promise of these drugs to help prevent cancer,” said Joel Saltzman, MD, an ASCO Expert in gastrointestinal cancers and Vice Chair of Regional Oncology at Taussig Cancer Center, Cleveland Clinic.

Researchers plan to validate these findings in randomised controlled clinical trials.

Source: ASCO