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ASPirin Intervention for the REDuction of Colorectal Cancer Risk (ASPIRED)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02394769
Recruitment Status : Active, not recruiting
First Posted : March 20, 2015
Results First Posted : March 23, 2021
Last Update Posted : September 2, 2022
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Andrew T. Chan, MD, MPH, Massachusetts General Hospital

Study Description
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Brief Summary:
This research study is investigating the use of aspirin as a potential chemopreventive agent to reduce risk of colorectal cancer

Condition or disease Intervention/treatment Phase
Colorectal Cancer Drug: Aspirin Drug: Placebo for Aspirin Not Applicable

Detailed Description:

This research study, is investigating the use of aspirin as a potential chemopreventive agent to reduce risk of colorectal cancer. Within the gastroenterology practice of Massachusetts General Hospital (MGH), we will conduct a prospective, double-blind, placebo-controlled, randomized clinical trial to measure the effects of daily low-dose (81 mg/day) and standard-dose (325 mg/day) aspirin on urine, plasma, stool, and tissue biomarkers associated with colorectal cancer.

Aspirin is part of the non-steroidal anti-inflammatory drug (NSAID) family, which are drugs routinely used for their pain-killing (analgesic), fever-reducing (antipyretic), or anti-inflammatory properties. Most NSAIDs are available as over-the-counter formulations. Substantial evidence has conclusively demonstrated that aspirin reduces the risk of colorectal neoplasia, yet there remains uncertainty surrounding its mode of action. Aspirin has already been established to reduce the risk of cardiovascular disease. Prospective studies as well as randomized clinical trials demonstrate that aspirin reduces the risk of precancerous polyps and colorectal cancer.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 180 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Prevention
Official Title: ASPIRED: ASPirin Intervention for the REDuction of Colorectal Cancer Risk
Actual Study Start Date : July 6, 2015
Actual Primary Completion Date : April 11, 2019
Estimated Study Completion Date : July 2029

Resource links provided by the National Library of Medicine

Drug Information available for: Aspirin

Arms and Interventions
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Arm Intervention/treatment
Placebo Comparator: Placebo (For Aspirin)
The first dose of the study medication will be given to patients after the initial flexible sigmoidoscopy (start of randomization). Participants will be expected to take one capsule orally at the blinded dose, once daily, until the final visit. Duration not to exceed 12 weeks.
 Drug: Placebo for Aspirin
Active Comparator: Low Dose Aspirin
The first dose of the study medication will be given to patients after the initial flexible sigmoidoscopy (start of randomization). Participants will be expected to take one capsule orally at the blinded dose (81 mg/d), once daily, until the final visit. Duration not to exceed 12 weeks.
 Drug: Aspirin
Other Names:
  • 2-Acetylsalicylic Acid
  • ASA
Active Comparator: Standard Dose Aspirin
The first dose of the study medication will be given to patients after the initial flexible sigmoidoscopy (start of randomization). Participants will be expected to take one capsule orally at the blinded dose (325mg/d), once daily, until the final visit. Duration not to exceed 12 weeks.
 Drug: Aspirin
Other Names:
  • 2-Acetylsalicylic Acid
  • ASA


Outcome Measures
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Primary Outcome Measures :
  1. Change in Urinary Prostaglandin Metabolites (PGE-M) [ Time Frame: 8-12 weeks ]
    Measured using liquid chromatography/mass spectrometry


Secondary Outcome Measures :
  1. Plasma Macrophage Inhibitory Cytokine-1 (MIC-1), an Inflammatory Biomarker [ Time Frame: 8-12 weeks ]
    Measured using an ELISA for MIC-1

  2. Chromatin Binding [ Time Frame: 8-12 weeks ]
    Measured using ChIP-Seq of DNA extracted from colonic epithelium

  3. Expression of Wnt-associated Signaling Genes (CTNNB1, AXIN2 and MYC) [ Time Frame: 8-12 weeks ]
    Measured using RNA-seq of colonic epithelium

  4. Spectral Biomarkers of Colorectal Cancer [ Time Frame: 8-12 weeks ]
    Measured using Partial Wave Spectroscopy on rectal cytology brushing samples


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Underwent screening or surveillance colonoscopy at MGH within the last 9 months with removal of at least one adenoma.
  • Age 18-80 years.
  • This study will only include adult participants because colorectal carcinogenesis in children is more likely to be related to a cancer predisposition syndrome with distinct biological mechanisms compared with sporadic colorectal cancer in adults. Patients over age 80 will not be enrolled since the benefits and risks of a daily aspirin regimen over the age of 80 have not yet been well-characterized.
  • ECOG performance status ≤2 (Karnofsky ≥60%, see Appendix A)
  • Not currently taking aspirin (any dose) within the last 6 months.
  • The effects of aspirin on the developing human fetus are unknown. For this reason, women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she is participating in this study, she should inform her treating physician immediately.
  • Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  • Use of any non-aspirin non-steroidal anti-inflammatory drug (NSAID) at any dose at least three times a week during the two months prior to randomization.
  • Diagnosis of inflammatory bowel disease, liver or kidney disease, bleeding diathesis
  • Any prior diagnosis of gastrointestinal cancer (including esophageal, small intestine, colon, pancreatic), or any diagnosis of other cancers (with the exception of non- melanoma skin) in which there has been any active treatment within the last three years
  • Participants who are receiving any other investigational agents.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to aspirin.
  • Known diagnosis of Familial Adenomatous Polyposis (FAP) or Hereditary Non-Polyposis Colorectal Cancer (HNPCC, Lynch Syndrome).
  • Any adenoma that was not completely removed during previous colonoscopy.
  • History of aspirin intolerance, bleeding diathesis, peptic ulcer or gastrointestinal bleed, endoscopic complications, or contraindication to colonoscopy.
  • Inability or unwillingness to abstain from non-protocol use of aspirin or NSAIDs or to provide blood, urine, or stool samples or colon biopsies during the study.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Pregnant or breastfeeding.
  • Pregnant women are excluded from this study because aspirin is an FDA Category D agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with aspirin, breastfeeding should be discontinued if the mother is treated with aspirin.
  • Participant must be able to swallow pills.
  • Participant is taking any anticoagulant agent (e.g. warfarin) or antiplatelet agent (e.g. clopidogrel).
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02394769


Locations
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United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Massachusetts General Hospital
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Andrew T Chan, MD, MPH Massachusetts General Hospital
  Study Documents (Full-Text)

Documents provided by Andrew T. Chan, MD, MPH, Massachusetts General Hospital:
Study Protocol and Statistical Analysis Plan  [PDF] February 14, 2019

More Information
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Publications:

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Responsible Party: Andrew T. Chan, MD, MPH, Principal Investigator, Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT02394769    
Other Study ID Numbers: 14-496
R01CA137178 ( U.S. NIH Grant/Contract )
First Posted: March 20, 2015    Key Record Dates
Results First Posted: March 23, 2021
Last Update Posted: September 2, 2022
Last Verified: August 2022

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Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by Andrew T. Chan, MD, MPH, Massachusetts General Hospital:
Colorectal Cancer
Additional relevant MeSH terms:
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Colorectal Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Digestive System Diseases
Gastrointestinal Diseases
Colonic Diseases
Intestinal Diseases
Rectal Diseases
Aspirin
Anti-Inflammatory Agents, Non-Steroidal
Analgesics, Non-Narcotic
 Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Inflammatory Agents
Antirheumatic Agents
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Platelet Aggregation Inhibitors
Cyclooxygenase Inhibitors
Enzyme Inhibitors
Antipyretics