Professor Yeng Ang

Drug combination could help prevent osophageal cancer in people at high risk

Two over-the-counter, widely available drugs could help cut cases of oesophageal cancer in people at higher risk of the disease, a new study has found.

The Cancer Research UK-funded clinical trial has also reported that when these drugs – a stomach acid blocker (esomeprazole) and aspirin – were used together, their effects were even greater.

The findings of the AspECT consortium mark an important step towards effective protection against cancer for people with Barrett’s oesophagus, a condition where acid reflux from the stomach damages the cells of the oesophagus. It is the biggest risk factor for oesophageal cancer, the sixth most common cause of cancer death worldwide.

Professor Yeng Ang, Consultant Gastroenterologist at Salford Royal and Honorary Professor of Gastroenterology at The University of Manchester, is the NW regional coordinator and a member of the Trial Management Group for the study, which recruited more than 2,500 patients throughout the UK between 2005 and 2009.

He said:  “Oesophageal cancer often doesn’t cause clear symptoms during its early stages, meaning many cases are diagnosed late when they’ve spread and become difficult to treat. That’s one of the main reasons why survival for oesophageal cancer is stubbornly low, with just over one in 10 people surviving their disease for a decade or longer. It’s time for this grim situation to be turned around and our research shows that’s possible.

“This was a huge study, with patients followed for an average of nine years, and the findings show that high dose proton-pump inhibitor (PPI – a stomach acid blocker) therapy not only reduced progression of people’s Barrett’s oesophagus, but cases of oesophageal cancer and the number of people dying from any cause were lower too. And when aspirin was added in to the mix, the effect was even greater.

“We were expecting PPI treatment to maybe reduce cases of oesophageal cancer by about five per cent.  But we found the reduction was more like 20 per cent in people given a high daily dose. Importantly, the drugs seemed to be safe too, with very few people experiencing side effects. But this is an important concern with using drugs to prevent cancer in this way, particularly aspirin, which is linked with bleeding risks when used long-term.”

The exact mechanism of how these drugs in combination works is still not entirely clear.

Professor Ang added: “This study will be practice-changing but other questions remain – how long do patients need to take these drugs for them to have a beneficial effect? Who is most likely to benefit from taking them? And importantly, can they prevent deaths specifically from oesophageal cancer?

“These will be the focus of future research. We are already drawing up plans to extend the study and hopefully this work can begin making an impact on people’s lives.”