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Lookup NU author(s): Professor John Mathers, Dr Anne-Marie Gerdes, Dr Harsh Sheth, Lynn ReedORCiD, Dr Gillian Borthwick, Professor Sir John BurnORCiD
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
©2022 The Authors; Published by the American Association for Cancer Research. ABSTRACT: The CAPP2 trial investigated the long-term effects of aspirin and resistant starch on cancer incidence in patients with Lynch syndrome (LS). Participants with LS were randomized double-blind to 30 g resistant starch (RS) daily or placebo for up to 4 years. We present long-term cancer outcomes based on the planned 10-year follow-up from recruitment, supplemented by National Cancer Registry data to 20 years in England, Wales, and Finland. Overall, 463 participants received RS and 455 participants received placebo. After up to 20 years follow-up, there was no difference in colorectal cancer incidence (n = 52 diagnosed with colorectal cancer among those randomized to RS against n = 53 on placebo) but fewer participants had non-colorectal LS cancers in those randomized to RS (n = 27) compared with placebo (n = 48); intention-to-treat (ITT) analysis [HR, 0.54; 95% confidence interval (CI), 0.33-0.86; P = 0.010]. In ITT analysis, allowing for multiple primary cancer diagnoses among participants by calculating incidence rate ratios (IRR) confirmed the protective effect of RS against non-colorectal cancer LS cancers (IRR, 0.52; 95% CI, 0.32-0.84; P = 0.0075). These effects are particularly pronounced for cancers of the upper GI tract; 5 diagnoses in those on RS versus 21 diagnoses on placebo. The reduction in non-colorectal cancer LS cancers was detectable in the first 10 years and continued in the next decade. For colorectal cancer, ITT analysis showed no effect of RS on colorectal cancer risk (HR, 0.92; 95% CI, 0.62-1.34; P = 0.63). There was no interaction between aspirin and RS treatments. In conclusion, 30 g daily RS appears to have a substantial protective effect against non-colorectal cancer cancers for patients with LS. PREVENTION RELEVANCE: Regular bowel screening and aspirin reduce colorectal cancer among patients with LS but extracolonic cancers are difficult to detect and manage. This study suggests that RS reduces morbidity associated with extracolonic cancers. See related Spotlight, p. 557.
Author(s): Mathers JC, Elliott F, Macrae F, Mecklin J-P, Moslein G, McRonald FE, Bertario L, Evans DG, Gerdes A-M, Ho JWC, Lindblom A, Morrison PJ, Rashbass J, Ramesar RS, Seppala TT, Thomas HJW, Sheth HJ, Pylvanainen K, Reed L, Borthwick GM, Bishop DT, Burn J
Publication type: Article
Publication status: Published
Journal: Cancer Prevention Research
Year: 2022
Volume: 15
Issue: 9
Pages: 623-634
Online publication date: 01/09/2022
Acceptance date: 01/07/2022
Date deposited: 20/09/2022
ISSN (print): 1940-6207
ISSN (electronic): 1940-6215
Publisher: American Association for Cancer Research
URL: https://doi.org/10.1158/1940-6207.CAPR-22-0044
DOI: 10.1158/1940-6207.CAPR-22-0044
PubMed id: 35878732
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