A Phase III, Randomized, Study of Aspirin and Esomeprazole Chemoprevention in Barrett's Metaplasia (AspECT)
Esophageal Cancer, Precancerous Condition
About this trial
This is an interventional prevention trial for Esophageal Cancer focused on measuring esophageal cancer, Barrett's esophagus
Eligibility Criteria
INCLUSION CRITERIA Aged ≥18 years. Circumferential Barrett's metaplasia of at least 1cm in length (≥C1M1) or a tongue of Barrett's metaplasia of at least 2cm in length (≥C0M2) (irrespective of the presence now or historically of histologically proven intestinal metaplasia). Able to give written informed consent. WHO performance status of 0 or 1 i.e. fully active and self-caring. EXCLUSION CRITERIA High grade dysplasia or carcinoma at enrolment. Medical conditions which would make completing endoscopies or completing the trial difficult including: Frequent transient ischaemic attacks (3 or more) or severe cerebral vascular accident in the previous 6 months* Severe respiratory disease with arterial oxygen saturation less 90% at rest Severe ischaemic heart disease (exercise tolerance less than 100 yards or life expectancy < 4 years) or myocardial infarction in the previous 3 months Severe inflammatory bowel disease requiring at least one hospital admission of 5 days in the last year or bowels open > 6 times/day * Patients answering yes to criterion a. were eligible for the PPI-only (non-aspirin) arms of the trial Continuous/frequent non-steroidal anti-inflammatory drug use or COX-2 inhibitors (more than 60 days per year in total). Patients with absolute contraindications to PPIs, aspirin or their excipients i.e. allergies, ulcers, renal impairment or use of oral anticoagulants. Pregnant or lactating women will not undergo endoscopy and may be given dispensation to stop drug therapy for a year. This should be discussed with the Trial Office. If a patient was suitable for inclusion but later becomes unsuitable this should be discussed with the Trial Office before they are withdrawn. Only in exceptional circumstances should patients not be followed up i.e. withdrawal of consent or current life threatening disease with poor outcome and therefore unable to tolerate endoscopy. In these circumstances patients should be followed up in outpatient clinics.
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Experimental
Experimental
Experimental
Experimental
Arm A
Arm B
Arm C
Arm D
20mg Esomeprazole
80mg Esomeprazole
20mg Esomeprazole + 300mg Aspirin
80mg Esomeprazole + 300mg Aspirin