Statins and Colorectal Cancer

Paul Lochhead; Andrew T. Chan

Disclosures

Clin Gastroenterol Hepatol. 2013;11(2):109-118. 

In This Article

Statin Use after a Diagnosis of Colorectal Cancer

Another high-risk group, in whom it may be possible to show benefit from statin use in shorter-term studies, are individuals who have already developed colorectal cancer. In a retrospective cohort study of 1309 male veterans with colorectal cancer,[92] more than 3 years of prediagnosis statin use was associated with lower tumor stage, lower prevalence of metastases, and higher frequency of proximal cancers, compared with nonusers. Survival analysis showed more favorable 5-year cancer-specific survival in statin users compared with nonusers. A significant limitation of this study was the inability to control for prediagnosis colorectal screening. In a randomized trial of adjuvant chemotherapy involving 842 patients with stage III colorectal cancer, prospective observational analysis of postdiagnosis statin use did not reveal any association with improved disease-free, recurrence-free, or overall survival.[93] A randomized phase II trial of chemoprevention with atorvastatin, sulindac, or dietary fiber, conducted in individuals with resected colorectal cancer or advanced adenomas, also failed to show a protective effect of statin therapy.[94] This study, which used rectal aberrant crypt foci as a surrogate end point was, however, underpowered, with only 85 subjects randomized to each of the 3 interventions or placebo.[94]

The safety of simvastatin as an adjunct to conventional chemotherapy for metastatic colorectal cancer has been shown by a completed phase II trial,[95] and a number of additional phase II and III studies are currently recruiting patients.[96] The National Surgical Adjuvant Breast and Bowel Project P-5 study is actively enrolling patients with resected stage I and II colon cancer.[97] Participants will be randomized to receive rosuvastatin or placebo for 5 years, and the effect of statin therapy on the incidence of adenomas, metachronous cancer, and colon cancer recurrence will be evaluated.[97]

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