Can Aspirin Use Improve Survival in Certain Patients With Head and Neck Cancer?

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin may help improve the chance of survival for some patients with cancer, according to a new study.
The study, published in the Journal of Experimental Medicine, suggests that regular use of aspirin may be effective against some types of head and neck squamous cell carcinoma (HNSCC). For the study, researchers from the University of Pittsburgh School of Medicine and the University of Arizona analyzed a group of 266 patients with HNSCC who had their tumors surgically removed and were treated with adjuvant chemotherapy and/or radiotherapy.
The researchers found that regular aspirin use dramatically improved survival for patients with mutations in a gene called PIK3A, which is the most commonly altered oncogene in HNSCC. Thirty-four percent of all tumors in HNSCC carry mutations that activate PIK3A, according to the study. Twenty-eight percent of the tumors in the study had an activating alteration of the PIK3A gene.
Overall, NSAIDs increased the overall 5-year survival rate from 25% to 78% in patients whose gene was mutated or amplified. However, there was no benefit shown in patients without any alterations in their PIK3A. Regular aspirin use was defined as taking 2 or more doses per week for at least 6 months, the researchers noted.
Aspirin was a component of the NSAID regimen in 93% of regular users and 73% took aspirin exclusively. Of those who were aspirin-exclusive, 75% took daily, low-dose (81 mg) aspirin. Most regular users (86%) initiated NSAID therapy after receiving their HNSCC diagnosis, but there was no indication that the diagnosis informed the decision to take NSAIDs, according to the study.
“Our study sequenced all PIK3CA exons and assessed the impact of both canonical and noncanonical PIK3CA mutations in addition to determining the contribution of gene amplification, thus implicating activation of PI3K signaling as the primary mechanism for NSAID benefit,” the researchers wrote in the study.
Additionally, NSAID use was found to reduce tumor growth in mice injected with cancer cells harboring a mutant PIK3CA gene, according to the study. The researchers determined that NSAIDs likely inhibit tumor growth by reducing the production of prostaglandin E2.
Despite the promising findings, the researchers noted that they are unable to make clear recommendations about NSAID use for these patients. However, they indicated that the findings warrant further study in a prospective randomized clinical trial.
“Our results suggest that the use of NSAIDs could significantly improve outcomes for not only head and neck cancer patients, but also patients with other cancers that contained the PIK3CA mutation,” senior author Jennifer R. Grandis, MD, a University of California San Francisco professor of otolaryngology, head and neck surgery, said in a press release.
Hedberg ML, Peyser ND, Bauman JE, et al. Use of nonsteroidal anti-inflammatory drugs predicts improved patient survival for PIK3CA-altered head and neck cancer. Journal of Experimental Medicine. 2019. Doi: 10.1084/jem.20181936.
Common Pain Reliever Can Improve Survival in Head and Neck Cancer [news release]. University of California San Francisco. Accessed January 28, 2019. 

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