Aspirin Helps Improve Liver Function for Hepatocellular Carcinoma Patients

F. Edward Boas, MD, PhD

Aspirin use could help patients dealing with hepatocellular carcinoma (HCC) retain liver function following transarterial chemoembolization or transarterial embolization (TAE).

Researchers from Memorial Sloan Kettering Cancer Center, led by F. Edward Boas, MD, PhD, assessed the mechanism that explains how aspirin therapy improves survival by examining 304 patients with HCC who were treated with TAE.

The patients were split into 2 separate groups based on whether they took aspirin or not at the time of the initial TAE, with 42 patients landing in the aspirin group.

The investigators measured the response of embolized tumors, time to progression, initial site of progression, survival time, and liver function test results both prior to and following embolization for the 2 groups of patients.

They found that aspirin use did not indicate a disparity in the initial response rate (88% vs. 90% complete response or partial response, p= .59), median time to progression (6.2 vs. 5.2 months, p= .42), initial site of progression (p= .77), or fraction of patients dying with disease progression (88% vs. 89%, p= 1.00), the median overall survival period after TAE for HCC measured longer for the cohort taking aspirin (57 vs. 23 months, p= .008).

Prior to embolization, there was no difference in mean bilirubin level (.8 vs. .9 mg/dl, p= .11), for either group.

They also found that the bilirubin level was significantly lower 1 day (.9 vs. 1.3, p< .001), 1 month (.9 vs. 1.2, p= .048), and 1 year (.8 vs. 1.0, p= .021) after embolization for the group of patients taking aspirin.

“Although the differences in liver function test results in the groups taking and not taking aspirin were small standard biochemical liver function tests are insensitive to early cirrhotic changes,” Boas said in a statement. “Small changes in biochemical liver function test results might underestimate the degree of liver injury after embolization.”

The median overall survival period after the initial embolization was longer (57 vs 23 months, p= .008) for the patients taking aspirin.

Because the study was retrospective, Boas said that a confounding variable could account for the improved survival among the patients taking aspirin, despite comparable liver function, American Joint Committee on Cancer stage, comorbidities and other clinical characteristics before embolization in both groups.

“Aspirin use is associated with improved liver function test results and survival after TAE for HCC,” the authors wrote. “It is not associated with differences in response or time to progression.”

Earlier this year the US Food and Drug Administration approved a new HCC therapy—Exelixis’ cabozantinib (Cabometyx).

“Patients with this form of advanced liver cancer have few treatment options, particularly once their disease progresses following treatment with sorafenib,” Ghassan K. Abou-Alfa, MD, CELESTIAL lead investigator from Memorial Sloan Kettering Cancer Center, said in a statement.

At 5.2 months of treatment with cabozantinib, median progression-free survival (PFS) was more than doubled compared to placebo, which was 1.9 months (HR .44, 95% CI .36-.52; p<.0001). Per RECIST 1.1, objective response rates with cabozantinib were 4% compared to .4% with placebo (p=.0086). In addition, 64% of patients in the cabozantinib group achieved disease control (partial response or stable disease) compared with 33% of patients in the placebo group.

The study, “Aspirin Is Associated with Improved Liver Function After Embolization of Hepatocellular Carcinoma,” was published online in the American Journal of Roentgenology.