Use of nonsteroidal anti-inflammatory drugs improved patient survival for PIK3CA-altered head and neck cancer (HNC).

A new study by UC San Francisco and University of Pittsburgh has found that regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, significantly improves survival for a third or more patients with HNC. 

NSAIDs improved the overall 5-year survival rate from 25% to 78% for patients whose cancer contained a specific altered gene, known as PIK3CA. The survival for patients whose gene was not altered was unaffected by NSAID use.

PIK3CA is the most commonly altered oncogene in head and neck squamous carcinoma, and is found in a third of all tumors. In HNC associated with the human papillomavirus (HPV), PIK3CA is mutated in more than half of tumors.

The retrospective study included 266 patients. Most patients (67%) received post-surgery chemotherapy and/or radiotherapy. PIK3CA gene activating alteration was found in 28% in the patients. Among the patients who regularly used NSAIDs, 93% used aspirin (81mg/day) as a component of the NSAID regiment, and 73% took aspirin exclusively.

The investigators learned that regular use of NSAIDs for at least 6 months provided markedly prolonged improved survival compared to non-use for patients whose PIK3CAgene was mutated or amplified. In these patients, NSAIDs raised overall five-year survival from 25% to 78%. However, patients without alterations in their PIK3CA gene were no better off by taking NSAIDs.

This is the first study to show a strong clinical advantage of regular NSAID use for HNC patients with mutations in the PIK3CA gene and may indicate a clear, biological reason to implement NSAID therapy in certain cases of HNC patients

Through analysis of both cell line and mouse studies, the researchers speculated that NSAIDs likely blocked tumor growth by reducing the production of an inflammatory molecule called prostaglandin E2.

The researchers have designed a prospective, randomized clinical trial to address the study’s limitations (small numbers and retrospective nature of the study) to assess the clinical significance of this therapeutic use.