ASCOLT began as an idea, in the wake controversy and the legal maelstrom engulfing COX2 inhibitors in the early 2000s. Rofecoxib was then temporarily withdrawn from the market due to concerns over its cardiovascular safety – and many adjuvant COX2 inhibitor cancer studies including VICTOR and EORTC PETACC 5 – were suspended or discontinued. Since aspirin was a non-selective inhibitor of COX, it made sense to evaluate Aspirin as an alternative to COX2 selective inhibitors especially since aspirin was cardio-protective and had a good long-term safety record. Further the potential adjuvant benefit of aspirin in colorectal cancer was also supported by observational findings presented in an ASCO abstract in 2005 by Dr Andrew Chan and Charles Fuchs.
ASCOLT thus began its germination in Singapore with a seed grant from the Singhealth Foundation in 2006, which allowed for contracts to be signed and preparatory work for the trial to begin. John and Han Chong met up with David Kerr and Raghib Ali from the University of Oxford and a partnership was quickly formed.
All parties recognized very early that the journey would not be easy. Although the idea and study design was extremely simple, the fact that aspirin was an off-patent drug meant that ASCOLT would have to be undertaken as an investigator-initiated academic study. Cross border investigator-initiated studies in Asia was still in its infancy. In Malaysia, Singapore, Indonesia, Taiwan, Hong Kong, Saudi Arabia, India and Korea and China, ASCOLT was fortunate to have already found support amongst friends (see photos and details in “Members Section”) who helped to drive the study at the early start. More recently, we are pleased to have developed friendships and partnership with the AGITG who will form a major arm of the study.
Funding for the expansion of ASCOLT has been supported by competitive grants from the National Medical Research Council Singapore and the Singapore Cancer Society, and supplemented via charitable donations from the Silent Foundation, Lee Kim Tah Foundation, and Lee Foundation. Recently, additional funding from the Rising Tide Foundation for Clinical Cancer Research based in Switzerland is also supporting the trial In Australia, funding has been achieved via an Australian Government NHMRC grant and the study drug has also been provided free of charge by Bayer Pharma AG.
The past decade has witnessed the emergence of strong indirect evidence supporting Aspirin’s role in preventing colon cancer recurrence. We are pleased to be the first clinical trial attempting to valid the effectiveness of aspirin in established cancers – and be part of a remarkable story for a pill that costs a penny. In Asia where several hundred millions people live below the poverty line access to healthcare that is both effective and affordable can be a stabilizing force for societies. In an era of rising global inequality if Aspirin can be proven to be effective in treating cancer, our study would be an important example how partnerships for clinical trials can yield large social and public-health returns.