08/08/2022
3 min read
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Mathers does not report relevant financial information. The relevant financial information of all other authors can be found in the study.
People with Lynch syndrome who took resistant-strength supplements for at least 2 years developed significantly fewer non-colorectal cancers, according to the results of a 10-year follow-up study in cancer prevention research showed.
The researchers found the most pronounced protective effect of resistant starch – also known as fermentable fiber – in malignancies of the upper gastrointestinal tract, including pancreatic, oesophageal, bile duct and stomach cancer.
Data derived from Mathers JC, et al. Cancer Back Res. 2022;doi:10.1158/1940-6207.CAPR-22-0044.
The findings could be the first to suggest that supplementation may help prevent certain forms of cancer in people with Lynch syndrome, the researchers noted.
background
Individuals with Lynch syndrome have an increased risk of several types of cancer—particularly colorectal cancer.
Researchers designed the international CAPP2 study to determine whether the effects of aspirin or resistant starch supplementation affect the development of subsequent cancers in people with Lynch syndrome.
John Mather
“We have a long-term interest in cancer prevention and have argued that conducting chemoprevention trials in people with hereditary cancers – like Lynch syndrome – is a very cost-effective way to not only find out what works in these patient populations, but also in providing evidence that may be relevant to cancer prevention in the general population”, John Mathers, BSc, Dip Nutr, PhD, Professor of human nutrition at Newcastle University in the UK, Healio said.
methodology
The multinational CAPP2 study used a 2 × 2 factorial design that allowed for concurrent assessment of aspirin intake and resistant-strength supplementation in people with Lynch syndrome. Study participants who agreed to take both interventions had an equal likelihood of being assigned to one of four study arms: aspirin plus resistant strength, placebo plus resistant strength, aspirin plus placebo, or dual placebos.
The current analysis included 918 study participants (mean age 45 years), of whom 463 received 30 g of resistant starch daily and 455 received placebo. Treatment continued for up to 4 years.
Mathers and colleagues presented data from a planned 10-year follow-up analysis of study results, supplemented with up to 20 years of national cancer registry data for 369 participants from England, Wales and Finland.
The primary endpoint of the study was the number, size and histological stage of the colorectal carcinomas. Secondary endpoints included the number, size, and histologic stage of Lynch syndrome-related non-colorectal cancers.
Important Findings
Twenty-year follow-up data showed no difference in the incidence of colorectal cancer between study participants who received resistant starch and those who received placebo.
However, using an intent-to-treat analysis, the researchers observed significantly fewer Lynch syndrome-related noncolorectal cancers in people who received resistant starch supplementation compared to placebo (27 vs. 48; HR = 0 .54; 95% CI, 0.33-0.86 ).
An incidence rate ratio of 0.52 (95% CI, 0.32-0.84) confirmed the significant protective effect of resistant starch against Lynch syndrome-associated non-colorectal cancer.
The researchers found the most outstanding protective effects against cancers of the upper gastrointestinal tract. Five study participants who received a drug-resistant starch supplement developed upper gastrointestinal cancer later than 21 of those who received a placebo.
Clinical Implications
The results of the CAPP2 study are the first to show that dietary intervention can reduce the risk of cancer in people with Lynch syndrome, Mathers said.
“This is clinically important because there are currently no easy-to-use ways to screen for these upper GI cancers, so they are typically diagnosed late,” he told Healio. “This is in contrast to colon cancer, [such as colorectal cancer, which] can be managed effectively through regular screening programs.”
People with Lynch syndrome don’t typically get screened for non-colorectal cancer regularly, so they’re often caught later and have more colorectal-related cancer-related deaths among those affected, Mathers said.
“In fact, cancers of the upper gastrointestinal tract are far more likely to be fatal than they actually are [colorectal cancers] in people with Lynch syndrome,” he added.
“We were disappointed to find that those randomized in the CAPP2 resistant starch study were very similar [colorectal cancer] Incidence among those randomized to placebo,” Mathers said. “However, we were very surprised – and encouraged – by the approximately 50 percent reduction in non-colorectal cancers in those randomized to resistant starch.”
For more informations:
John Mather, BSc, Dipl. Nutr, promotion, available from the Population Health Sciences Institute, Room 2.060, William Leech Building, Newcastle University, Newcastle on Tyne, NE2 4HH, United Kingdom; Email: [email protected].
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