Feel the burn.

Headline: The largest chemoprevention trial ever performed for esophageal cancer demonstrates that the proton pump inhibitor esomeprazole (aka Nexium) in combo with aspirin significantly reduces progression to at least high-grade dysplasia (HGD) and/or death among patients with known Barrett’s esophagus.
The Study: The UK ASPECT trial randomized >2500 patients in a 2x2 design to esomeprazole 40 mg twice daily (high dose) or 20 mg daily (low dose) with or without aspirin 300 mg daily. At a median follow-up of 9 years, the primary endpoint of time to progression to HGD, esophageal cancer, or death was significantly prolonged by the combo of high dose esomeprazole in combo with aspirin, achieving a time to event ratio of 1.59 (95% CI 1.14-2.23). As expected, the adverse event rate didn’t surpass 1%. Optimal duration of these meds is still uncertain, but esophageal cancer can now join its neighbor among the coveted few malignancies with effective preventions packed in a pill.
Bottom Line: Esomeprazole 40 mg twice daily in combo with aspirin 300 mg daily is a safe and effective chemoprevention strategy for your patients with Barrett’s esophagus. | Jankowski, ASCO 2018