As an oncologist I’m particularly interested in the treatment of cancer and there has been some interesting data in the last five years, particularly the meta-analyses from Peter Rothwell’s group where he has been looking at cancer outcomes from randomised trials that were primarily designed to look at the vascular effects of aspirin. These have been very informative.

Also there have been the results of the CAPP 2 trial which was looking at patients with Lynch Syndrome, which means they have a hereditary predisposition to developing cancer. In this study patients were randomised between aspirin 600mg daily and a placebo. After a period of greater than five years the patients who were on aspirin developed significantly fewer cancers than those that were on the placebo.

In addition to that there has also been data on aspirin use after a cancer diagnosis. At the present time there are no randomised studies but when we look at several different cancers, for example colorectal cancer, breast cancer, and most recently prostate cancer, it seems that if you take aspirin after your diagnosis it’s less likely that your cancer will come back and overall survival is improved.

Could you discuss the ‘Add Aspirin’ trial?

The Add-Aspirin trial proposal, the plan is to have four separate trials with an overarching protocol. We’re going to take patients with colorectal cancer, with breast cancer, with prostate cancer and with gastro-oesophageal cancer and for each of those cohorts they will have had their primary treatment and then after that we will randomise them either to a placebo or aspirin 100mg daily for at least five years or aspirin 300mg daily for at least five years. Each of the trials will be individually powered and there will be a primary outcome measure which is specific for the tumour type. So for colorectal cancer and breast cancer it will be disease free survival; for gastro-oesophageal cancer it will be overall survival as the outcomes are poorer, and for prostate cancer it will be biochemical relapse free survival.

We’re also hoping to run the trial both in the UK and in India because aspirin is a low-cost generic drug and could be particularly useful in low resource settings as well.

Which types of cancer will you look at?

In India we’ll just look at breast cancer and gastro-oesophageal cancer

Are there any differences between population in Europe and India?

There may well be and also there are some differences in the incidence of cancer. So, for example, prostate cancer is really quite rare in India compared to the UK.