Aspirin Associated With Reduced Mortality in Patients With CRC CCO Independent Conference Highlights of the 2015 ASCO Annual Meeting* May 29 - June 2, 2015 *CCO is an independent medical education company that provides state-of-the-art medical information to healthcare professionals through conference coverage and other educational programs. CRC, colorectal cancer. This program is supported by educational grants from AstraZeneca, Bayer, Celgene Corporation, Genentech, Incyte, and Novartis.

Aspirin as Secondary Prevention in CRC: Background Regular aspirin use associated with reduced CRC incidence and mortality[1,2] Utility as primary prevention in general population debatable given risk of serious hemorrhagic adverse effects Utility as secondary prevention may be more justified from risk–benefit prospective and considering that aspirin reverses tumor immune evasion in established CRC Current observational study represents largest cohort ever examined evaluating effects of aspirin as secondary prevention[3] CRC, colorectal cancer. 1. Lii P, et al. Gut. 2014;[Epub ahead of print]. 2. Flossmann E, et al. Lancet. 2007;369:1603-1613. 3. Bains S, et al. ASCO 2015. Abstract 3504.

Aspirin as Secondary Prevention in CRC: Study Design Observational population-based cohort study in Norway Cancer Registry of Norway and Norwegian Prescription Database used to retrospectively link pts diagnosed with CRC from 2004-2011 and their use of aspirin Aspirin use defined as aspirin prescription for > 6 mos following CRC diagnosis Registries cover > 99% of Norwegian population and provide high-quality, validated data Primary endpoints: OS, cancer-specific survival CRC, colorectal cancer; OS, overall survival. Bains S, et al. ASCO 2015. Abstract 3504.

Aspirin as Secondary Prevention in CRC: Baseline Characteristics Aspirin Use P Value No (n = 19,535) Yes (n = 6109) Mean age, yrs 70.0 74.0 NR Male, % 48.8 56.4 < .001 Tumor differentiation, % Well Moderate Poor Undifferentiated 6.0 60.9 18.2 0.2 7.2 65.9 14.3 Site of disease, % Right Transverse Left Rectum 30.9 6.9 26.3 34.2 32.7 6.6 26.4 32.9 .042 CRC, colorectal cancer; NR, not reported. Bains S, et al. ASCO 2015. Abstract 3504.

Aspirin as Secondary Prevention in CRC: Baseline Characteristics continued Aspirin Use P Value No (n = 19,535) Yes (n = 6109) AJCC disease stage I II III IV 20.3 27.1 26.6 23.6 26.0 34.5 26.2 9.4 < .001 Survival status Alive Dead due to CRC Dead due to other reasons Dead due to reasons unknown 61.1 32.5 5.2 1.1 65.8 19.2 10.9 4.1 Underwent primary surgery 88.1 95.8 .08 AJCC, American Joint Committee on Cancer; CRC, colorectal cancer. Bains S, et al. ASCO 2015. Abstract 3504.

Aspirin as Secondary Prevention in CRC: OS and CSS Survival Outcome Univariate Analysis Multivariate Analysis HR (95% CI) P Value OS 1.03 (0.98-1.08) .25 0.86 (0.81-0.91) < .001 CSS 0.84 (0.79-0.90) 0.75 (0.70-0.81) CRC, colorectal cancer; CSS, cancer-specific survival; OS, overall survival.

Aspirin as Secondary Prevention in CRC: Conclusions In a cohort of more than 25,000 Norwegian individuals, aspirin use after CRC diagnosis independently associated with improved clinical outcomes Risk of CRC-specific mortality reduced by 25% Risk of all-cause mortality reduced by 14% CRC, colorectal cancer. Bains S, et al. ASCO 2015. Abstract 3504.

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