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Traitement adjuvant du cancer colorectal : l’aspirine, une biothérapie ciblée ?

Adjuvant therapy in colorectal cancer: aspirin, a targeted therapy?

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Oncologie

Résumé

Malgré l’efficacité des chimiothérapies adjuvantes dans le cancer colorectal (CCR), la moitié des patients ayant reçu une chirurgie à visée curative vont présenter une récidive. Il paraît donc essentiel de trouver des thérapies adjuvantes plus efficaces. La prise régulière d’aspirine diminue l’incidence des CCR et des adénomes. Cet effet antinéoplasique passerait au moins en partie par une modulation de la voie PIK3/AKT via l’inhibition de la cyclo-oxygénase 2. Récemment, deux études rétrospectives suggèrent fortement que l’aspirine consommée à faible dose après le diagnostic d’un CCR aurait un effet protecteur majeur sur le risque de récidive chez les patients présentant une tumeur avec une mutation PIK3CA, cependant ces notions n’ont pas été confirmées dans une étude récente présentée à l’ASCO GI 2014. Sa toxicité, spécialement chez le sujet âgé, pourrait cependant limiter son utilisation en pratique clinique. Une évaluation prospective randomisée de l’aspirine à faible dose après exérèse d’un CCR avec mutation PIK3CA est donc requise.

Abstract

Despite the efficacy of adjuvant chemotherapy in colorectal cancer (CRC), almost half of all patients who undergo surgical resection with curative intent will experience relapse. It remains a necessity to find an adjuvant therapy that is more effective. Regular use of aspirin reduces the risk of CRC and adenoma’s development. This antineoplastic effect is partially due to inhibition of PIK3/AKT pathway through COX-2 inhibition. Two recent retrospective studies suggested that regular use of aspirin after CRC diagnosis improves survival and decreases the risk of recurrence in patients with PIK3CA-mutated tumour, but it was not confirmed in a recent study. Aspirin could be active as a targeted therapy. However, the adverse events, particularly in older patients, could limit its use in routine clinical practice. A prospective randomized evaluation is required after the resection of CRC with PIK3CA mutation.

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Authors and Affiliations

  1. Service d’oncologie digestive, hôpital La Timone, Aix-Marseille université, 264, rue Saint-Pierre, F-13005, Marseille, France

    C. Sibertin-Blanc, L. Dahan & J.-F. Seitz

  2. Service d’hépatogastroentérologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, F-76031, Rouen cedex, France

    P. Michel

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  1. C. Sibertin-Blanc
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  2. L. Dahan
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  3. P. Michel
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  4. J.-F. Seitz
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Correspondence to J.-F. Seitz.

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Sibertin-Blanc, C., Dahan, L., Michel, P. et al. Traitement adjuvant du cancer colorectal : l’aspirine, une biothérapie ciblée ?. Oncologie 16, 509–515 (2014). https://doi.org/10.1007/s10269-014-2463-2

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  • DOI: https://doi.org/10.1007/s10269-014-2463-2

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