Correspondence

Aspirin and Hormone Therapy for Prostate Cancer

N Engl J Med 2007; 357:2737-2738December 27, 2007

Article

To the Editor:

Abnormal liver-function tests have been reported in 5% of patients taking high-dose aspirin for rheumatoid arthritis or osteoarthritis.1 A study of castrated rabbits revealed that serum levels of acetylsalicylic acid after oral aspirin administration were significantly higher than expected.2 This effect was attributed to slow metabolism of aspirin as a result of low testosterone levels. In men with prostate cancer, this effect of aspirin on liver-function tests could have clinical importance because the antiandrogen component of hormone therapy is discontinued when liver-function tests become abnormal.

We investigated whether the use of low-dose aspirin affects liver-function tests, and thereby interferes with the ability to deliver a full course of hormone therapy, in 206 men with localized but high- or intermediate-risk prostate cancers who were enrolled in a randomized trial3 comparing radiation therapy alone with radiation therapy plus hormone therapy. Hormone therapy consisted of 6 months of a luteinizing hormone–releasing hormone (LHRH) agonist and the antiandrogen flutamide. A logistic-regression multivariable analysis4 was used to assess whether an association existed between commonly used drugs (baby aspirin or atorvastatin) and the discontinuation of flutamide due to elevated values on liver-function tests. The use of baby aspirin was significantly associated with abnormal liver-function tests (P=0.02), whereas the use of atorvastatin was not (P=0.13). Flutamide was prematurely discontinued in 37% of aspirin users, as compared with 16% of nonusers, because of abnormal liver-function tests. Moreover, after a median follow-up period of 7.6 years and adjustment for known prognostic factors and interactions, and with men who completed 6 months of hormone therapy with both the LHRH agonist and flutamide as the comparison group, the risk of death was 3.5 times as high among men who completed 6 months of the LHRH agonist but discontinued flutamide early (P=0.04) and 6.1 times as high among men treated with radiation therapy alone (P<0.001) (Table 1Table 1Relative Risk of Death According to Treatment and Selected Baseline Characteristics among 206 Men with Prostate Cancer.). These data show that a commonly used drug can alter the tolerability of anticancer therapy.

Anthony V. D'Amico, M.D., Ph.D.
Philip W. Kantoff, M.D.
Dana–Farber Cancer Institute, Boston, MA 02115
adamico@partners.org

Ming-Hui Chen, Ph.D.
University of Connecticut, Storrs, CT 06268

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Citing Articles (3)

Citing Articles

1. 1

   Akash Nanda, Ming-Hui Chen, Brian J. Moran, Michelle H. Braccioforte, Daniel Dosoretz, Sharon Salenius, Michael Katin, Rudi Ross, Anthony V. D'Amico. (2010) Total Androgen Blockade Versus a Luteinizing Hormone–Releasing Hormone Agonist Alone in Men With High-Risk Prostate Cancer Treated With Radiotherapy. International Journal of Radiation Oncology*Biology*Physics 76:5, 1439-1444
   CrossRef

2. 2

   Ronald C. Chen, Natalia Sadetsky, Ming-Hui Chen, Peter R. Carroll, Anthony V. D'Amico. (2009) Maximum vs. Mono Androgen Blockade and the Risk of Recurrence in Men With Localized Prostate Cancer Undergoing Brachytherapy. International Journal of Radiation Oncology*Biology*Physics 75:1, 36-39
   CrossRef

3. 3

   Mary-Ellen Taplin. (2008) Androgen receptor: role and novel therapeutic prospects in prostate cancer. Expert Review of Anticancer Therapy 8:9, 1495-1508
   CrossRef