Efektivitas, Dosis, dan Pertimbangan Penggunaan Aspirin Jangka Panjang Sebagai Agen Kemopreventif Kanker Kolorektal
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Jun 7, 2020
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Abstract
Pendahuluan: Kanker kolorektal merupakan kanker paling umum ketiga untuk laki-laki dan paling umum kedua untuk perempuan dengan 1,65 juta kasus baru dan hampir 835.000 kematian di seluruh dunia pada tahun 2015. Tingginya insiden dan angka kematian menunjukkan krusialnya upaya pencegahan kanker kolorektal. Aspirin sudah banyak diselidiki sebagai agen pencegahan kanker kolorektal. Meski demikian, Komite Penanggulangan Kanker Nasional Kemenkes RI mengikuti pedoman American Cancer Society tidak merekomendasikan penggunaannya karena efektivitas, dosis yang tepat, dan potensi toksik yang belum diketahui secara pasti. Metode: Artikel ini dibuat dengan metode telaah pustaka sistematis dari jurnal online dan buku. Sumber pustaka diperoleh dari basis data online ScienceDirect, EBSCO Host, Proquest, dan PubMed. Setelah penyaringan dan pemilihan literatur dengan kriteria inklusi, analisis dan sintesis dibuat dari studi-studi ilmiah yang terpilih. Pembahasan: Penggunaan aspirin efektif menurunkan risiko kanker kolorektal hingga 29% dengan memengaruhi jalur neoplastik dalam karsinogenesisnya. Aspirin sebagai kemopreventif diberikan pada pasien usia 50-69 tahun dengan risiko tinggi kanker kolorektal dengan dosis optimal 75-325 mg/hari sebanyak 2-7 kali/minggu selama minimal 5 tahun. Penggunaan jangka panjang dengan dosis tersebut tidak menjadi masalah karena aspirin mudah didapatkan dan relatif murah serta memiliki efek samping minimal. Kesimpulan: Aspirin dapat digunakan sebagai agen kemopreventif primer dan sekunder kanker kolorektal yang efektif, murah, dan mudah didapat dengan efek samping minimal.
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Stevanny, B., & Maretzka, A. (2020). Efektivitas, Dosis, dan Pertimbangan Penggunaan Aspirin Jangka Panjang Sebagai Agen Kemopreventif Kanker Kolorektal. JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia, 6(2), 76-86. Retrieved from https://bapin-ismki.e-journal.id/jimki/article/view/183
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References
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24. Qin, Z. Y., et al. “Cyclooxygenase-2 expression and Its Association With Vascular Endothelial Growth Factor, Microvessel Density and Clinicopathologic Characteristics of Colorectal Carcinoma”. Bangladesh J Pharmacol. 11 (2016): 110–5. 25. Rao, C.V., et al. “Lipoxygenase and Cyclooxygenase Pathways and Colorectal Cancer Prevention.” Current Colorectal Cancer Reports. 8:4 (2012): 316–24.
26. Wang, Y., et al. "TGF-ß1 Mediates The Effects of Aspirin on Colonic Tumor Cell Proliferation and Apoptosis". Oncol Lett. 15:4 (2018): 5908–9.
27. Ye, X., et al. "Dose–Risk and Duration–Risk Relationships between Aspirin and Colorectal Cancer: A Meta-Analysis of Published Cohort Studies". PLoS One. 8:2 (2013): e57578.
28. Rodriguez, L. A. G., et al. "New Use of Low-Dose Aspirin and Risk of Colorectal Cancer by Stage at Diagnosis: A Nested Case–Control Study in UK General Practice. BMC Cancer. 17 (2017): 637.
29. Algra, A. M. dan Rothwell, P. M.. “Effects of Regular Aspirin on Long-Term Cancer Incidence and Metastasis: a Systematic Comparison of Evidence from Observational Studies Versus Randomised Trials”. Lancet Oncol. 13:5 (2012): 518–27.
30. Garcia-Albeniz, X., and Chan, A.T. “Aspirin for the Prevention of Colorectal Cancer.” Best Pract Res Clin Gastroenterol. 25 (2012): 461–72.
31. 31 D "Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator Plus". American College of Cardiology. 2018. 12 Agustus 2018.
32. Kuipers, E.J., et al. "Colorectal Cancer". Nat Rev Dis Primers. 1 (2015):15065.
33. Gilman, A. G.. Goodman & Gilman Dasar Farmakologi Terapi, Ed. 10, Vol. 2. Penerjemah Tim Alih Bahasa Sekolah Farmasi ITB. Jakarta: EGC, 2012. Terjemahan dari Goodman & Gilman’s the Pharmacological Basis of Therapeutics, 10th Ed, 2001. 675–6.
34. Huang, E. S., et al. “Long Term Use of Aspirin and the Risk of Gastrointestinal Bleeding.” The American Journal Of Medicine. 124:5 (2011): 426–33.
35. Elwood, P. C., et al. “Systematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk.” PLoS One. 11:11 (2016): e0166166.
2. "Indonesia: Estimated Age-Standardised Incidence and Mortality Rates: Both Sexes". GLOBOCAN 2012: Estimated Cancer Incidence, Mortality, and Prevalence Worldwide in 2012. 2012. WHO. 6 Juni 2018.
3. Cooper, K., et al. “Chemoprevention of Colorectal Cancer: Systematic Review and Economic Evaluation”. Health Technol Assess. 14:31 (2010): 1–206.
4. A Komite Penanggulangan Kanker Nasional (KPKN) Kemenkes RI. Pedoman Nasional Pelayanan Kedokteran Kanker Kolorektal. Oleh Ibrahim Basir, et al. Juli 2017. 12 Agustus 2018.
5. "Final Recommendation Statement Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication". U.S. Preventive Services Task Force. 2016. 12 Agustus 2018.
6. American Cancer Society. Colorectal Cancer Facts & Figures 2017-2019. Atlanta: American Cancer Society, 2017.
7. Landskron, G., et al. “Chronic Inflammation and Cytokines in the Tumor Microenvironment.” J Immunol Res. (2014): 149185.
8. Menter, D. G. dan Dubois, R. N.. “Prostaglandins in Cancer Cell Adhesion, Migration, and Invasion”. Int J Cell Biol. 723419 (2012).
9. “Acetylsalicylic Acid”. Drugbank. 2018. 8 Juni 2018. https://www.drugbank.ca/drugs/DB00945
10. Ugurlucan, M., et al. “Aspirin: From a Historical Perspective. Recent Pat Cardiovasc Drug Discov. 7:1 (2012): 71-6.
11. Boutaud, O. "Inhibition of the Biosynthesis of Prostaglandin E2 By Low-Dose Aspirin: Implications for Adenocarcinoma Metastasis". Cancer Prev Res (Phila). 9:11 (2016): 855-65.
12. “Aspirin”. MIMS (The Monthly Index of Medical Specialities). 2018. 8 Juni 2018. http://www.mims.com/ indonesia/drug/info/aspirin?mtype=generic
13. Chubak, J., et al. "Aspirin Use for the Prevention of Colorectal Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force". Evidence Synthesis. 133 (2015).
14. Soriano, L. C., Gabarro, M. S., dan Rodriguez, L. A. G. "Incidence of colorectal cancer in new users and non-users of low-dose aspirin without existing cardiovascular disease: A cohort study using The Health Improvement Network". Int J Cardiol. 248 (2017): 378–81.
15. Algra, A. M. dan Rothwell, P. M.. “Effects of Regular Aspirin on Long-Term Cancer Incidence and Metastasis: a Systematic Comparison of Evidence from Observational Studies versus Randomised Trials”. Lancet Oncol. 13:5 (2012): 518–27.
16. Soon, S. S., et al. "Cost-Effectiveness of Aspirin Adjuvant Therapy in Early Stage Colorectal Cancer in Older Patients". PLoS One. 9:9 (2014): e107866.
17. Drew, D. A., et al. "ASPirin Intervention for the REDuction of Colorectal Cancer Risk (ASPIRED): a Study Protocol for a Randomized Controlled Trial". Trials. 18:1 (2017): 50. 18. Dixon, D. A., et al. “Chapter 2: Mechanistic Aspects of COX-2 Expression in Colorectal Neoplasia.” Recent results Cancer Res. 191 (2013): 7–37.
19. “The Crosstalk of PTGS2 and EGF Signaling Pathways in Colorectal Cancer - Scientific Figure”. Research Gate. 2018. 11 Agustus 2018.
20. Jang, K. Y., et al. “Expression of Cyclin D1 is Associated with β-Catenin Expression and Correlates with Good Prognosis in Colorectal Adenocarcinoma”. Translational Oncology. 5:5 (2012):370–8.
21. Wang, Q., et al. “Deptor Is a Novel Target of Wnt/β-Catenin/c-Myc and Contributes to Colorectal Cancer Cell Growth”. Cancer Res. 78:12 (2018): 3163–75.
22. Gong, A. dan Huang, S. “FoxM1 and Wntβ-Catenin Signaling in Glioma Stem Cells.” Cancer research. 72:22 (2012): 5658–62.
23. Dovizio, M., et al. "Mechanistic and Pharmacological Issues of Aspirin as an Anticancer Agent". Pharmaceuticals. 5:12 (2012): 1346–71.
24. Qin, Z. Y., et al. “Cyclooxygenase-2 expression and Its Association With Vascular Endothelial Growth Factor, Microvessel Density and Clinicopathologic Characteristics of Colorectal Carcinoma”. Bangladesh J Pharmacol. 11 (2016): 110–5. 25. Rao, C.V., et al. “Lipoxygenase and Cyclooxygenase Pathways and Colorectal Cancer Prevention.” Current Colorectal Cancer Reports. 8:4 (2012): 316–24.
26. Wang, Y., et al. "TGF-ß1 Mediates The Effects of Aspirin on Colonic Tumor Cell Proliferation and Apoptosis". Oncol Lett. 15:4 (2018): 5908–9.
27. Ye, X., et al. "Dose–Risk and Duration–Risk Relationships between Aspirin and Colorectal Cancer: A Meta-Analysis of Published Cohort Studies". PLoS One. 8:2 (2013): e57578.
28. Rodriguez, L. A. G., et al. "New Use of Low-Dose Aspirin and Risk of Colorectal Cancer by Stage at Diagnosis: A Nested Case–Control Study in UK General Practice. BMC Cancer. 17 (2017): 637.
29. Algra, A. M. dan Rothwell, P. M.. “Effects of Regular Aspirin on Long-Term Cancer Incidence and Metastasis: a Systematic Comparison of Evidence from Observational Studies Versus Randomised Trials”. Lancet Oncol. 13:5 (2012): 518–27.
30. Garcia-Albeniz, X., and Chan, A.T. “Aspirin for the Prevention of Colorectal Cancer.” Best Pract Res Clin Gastroenterol. 25 (2012): 461–72.
31. 31 D "Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator Plus". American College of Cardiology. 2018. 12 Agustus 2018.
32. Kuipers, E.J., et al. "Colorectal Cancer". Nat Rev Dis Primers. 1 (2015):15065.
33. Gilman, A. G.. Goodman & Gilman Dasar Farmakologi Terapi, Ed. 10, Vol. 2. Penerjemah Tim Alih Bahasa Sekolah Farmasi ITB. Jakarta: EGC, 2012. Terjemahan dari Goodman & Gilman’s the Pharmacological Basis of Therapeutics, 10th Ed, 2001. 675–6.
34. Huang, E. S., et al. “Long Term Use of Aspirin and the Risk of Gastrointestinal Bleeding.” The American Journal Of Medicine. 124:5 (2011): 426–33.
35. Elwood, P. C., et al. “Systematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk.” PLoS One. 11:11 (2016): e0166166.