Aspirin, PIK3CA and Cancer

Very early on in my research I came across a meta study on aspirin and its possible impact on Cancer. It was one of the first topics I discussed with my oncologist. He told me that Aspirin can help prevent cancer, but once you have it there is no evidence that it is of any benefit. He advised me that taking Aspirin together with Avastin is a potentially dangerous combination as it can increase the risk of bleeding and stroke.

I was however armed with a meta study published in the New England Journal of Medicine, which showed a significant increase in Overall Survival in patients who took even low dose aspirin. This effect was only seen in patients with the PIK3CA mutation. My oncologist dismissed the study not even bothering to actually look it up. His attitude was like, “you are just the patient, what the hell do u know about cancer and stuff”. Anyway, I asked him to organize a PIK3CA test as I did not want to start taking aspirin if there would be no benefit. From my research I knew that even with positive KRAS test, I still had an 11% chance of also having this second mutation.

Two weeks later during my next visit, I enquired about the PIK3CA test. To my shock I was told that that test is non standard and he did not organize it and refused to do so. When I argued, I was given the phone number to the lab that had my biopsy and was told that if I wanted it done, to organize it myself. I also wanted the BRAF and NRAS tests done. The other argument, was that with KRAS having BRAF etc. was not possible as these were mutually exclusive. I did my research and I knew that all three mutations can co-exist with KRAS, though the probabilities were low. So I again tried to educate my oncologist, but I am sure It fell on deaf ears yet again.

Later in the week I rang the lab, but was told that only an oncologist could request the additional tests. Great! Fortunately I was told that the tests were already ordered. It turns out that my oncologist inadvertently requested all four tests as part of KRAS. Only KRAS came back due to a backlog at the lab and a holiday taken by one of the lab technicians. Two weeks later I had my results. đŸ™‚

During the next visit, my oncologist surprised me and had a printout of the aspirin study that I had mentioned earlier. He also read it, shock horror. What happened I thought? It turns out that my PIK3CA test was positive and I had a mutation in the PIK3CA gene as well. The lab report referred to the same study I had found, saying that there is evidence that patients with this mutation can benefit from aspirin. My oncologist, then went on to recommend that I start taking low dose aspirin and that the risk of taking it vith avastin was worth it. He learned that Aspirin was valuable, that the non-standard tests for PIK3CA could have value and that BRAF, NRAS and PIK3CA mutations can all co-exist with KRAS. From that day I felt that his attitude changed, and was no longer as dismissive of new information that I brought forward. This problem I found with many oncologists both traditional and alternative. They think of themselves as gods and as such know it all, hence the frequent arrogance.

As of that day, I have been on 100mg of aspirin daily. If you have not had your PIK3CA test done, it is a good idea to have it done as it can potentially buy you an additional year of life.

Resources

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1207756

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About Ren

I have been diagnosed with stage 4, metastatic colorectal cancer in October 2012, 3 days after my 44th birthday. There is no cure, but I am determined to go down the road less travelled to find one. I have setup this blog to document my journey and hopefully help others in the process. My view is that if there is a cure, it does not lie with traditional chemo, but with the immune system. Time will tell.
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