(TCP002) ASPIRIN AND ENDOMETRIAL CANCER: RE-VISITING THE ANTITHROMBOTIC/ANTI-CANCER PROPERTIES

Background: Endometrial cancer (EC) is among the 4 top cancers diagnosed in women and is highly thrombogenic. Cardiovascular events are among the prominent causes of death in EC patients. Aspirin is a common anti-platelet drug in cardiovascular disease but its value in cancer has only been described in a few cancer types and there is a high chance for beneficial effect of aspirin in EC. In this study, we aim to explore the literature to assess the use of aspirin in EC preventive and therapeutic regimens.

METHODS AND RESULTS: Due to sparsity of data in this field we applied a narrative review style for the study. We searched the PubMed database using MeSH terms “Endometrial Neoplasms” and “Aspirin" without any limitation or filters. Studies focusing on non-steroidal anti-inflammatory drugs instead of aspirin and those with focus on all or different cancer types other than EC were excluded. Checking the references within the references also showed acceptable precision in the selected articles for this narrative exploration.

Nineteen articles resulted from this search, and were divided into 4 categories including in vitro, preventive, therapeutic and review articles (Table 1). Overall, the findings for use of aspirin for prevention and adjuvant use were more abundant compared to the observations negating its use. However, three factors prevented making a clear recommendation about aspirin use in EC. First, lack of studies exclusively evaluating the cardiovascular outcomes of aspirin in EC. Secondly, a considerable number of studies were not able to find a positive effect for aspirin. However, a reassuring safety profile for aspirin was found regarding the bleeding risk during chemotherapy or surgical interventions. Thirdly, in one of the screened studies, increased mortality rate was reported for aspirin use. Specifically, the evidence to support aspirin use as an antithrombotic agent in EC is very low.

Conclusion: The current evidence for the value of aspirin use in EC is sparse and limited. The results of this literature exploration can be a foundation for proposing a series of systematic investigations (Figure 1) to define the role, indications, and contraindications of aspirin therapy in EC patients with more clarity and targeted clinical and practical value.