Coffee consumption may be associated with reduced risk of disease progression and death in patients with advanced or metastatic colorectal cancer, found a Dana-Farber Cancer Institute study drawing on data from a large phase 3 clinical trial.
The findings, based on data from a large observational study nested in a clinical trial, are in line with earlier studies showing a connection between regular coffee consumption and improved outcomes in patients with non-metastatic colorectal cancer.
The investigators found that in 1,171 patients treated for metastatic colorectal cancer, those who reported drinking two to three cups of coffee a day were likely to live longer overall, and had a longer time before their disease worsened, than those who didn't drink coffee. Participants who drank larger amounts of coffee – more than four cups a day – had an even greater benefit in these measures. The benefits held for both caffeinated and decaffeinated coffee.
The findings enabled investigators to establish an association, but not a cause-and-effect relationship, between coffee drinking and reduced risk of cancer progression and death among study participants. As a result, the study doesn't provide sufficient grounds for recommending, at this point, that people with advanced or metastatic colorectal cancer start drinking coffee on a daily basis or increase their consumption of the drink, researchers say.
"It's known that several compounds in coffee have antioxidant, anti-inflammatory, and other properties that may be active against cancer," says Dana-Farber's Dr Chen Yuan, the co-first author of the study with Dr Christopher Mackintosh, of the Mayo Clinic School of Medicine. "Epidemiological studies have found that higher coffee intake was associated with improved survival in patients with stage 3 colon cancer, but the relationship between coffee consumption and survival in patients with metastatic forms of the disease hasn't been known."
The study drew on data from the Alliance/SWOG 80405 study, a phase III clinical trial comparing the addition of the drugs cetuximab and/or bevacizumab to standard chemotherapy in patients with previously untreated, locally advanced or metastatic colorectal cancer. As part of the trial, participants reported their dietary intake, including coffee consumption, on a questionnaire at the time of enrolment. Researchers correlated this data with information on the course of the cancer after treatment.
They found that participants who drank two to three cups of coffee per day had a reduced hazard for death and for cancer progression compared to those who didn't drink coffee. (Hazard is a measure of risk.) Those who consumed more than four cups per day had an even greater benefit.
"Although it is premature to recommend a high intake of coffee as a potential treatment for colorectal cancer, our study suggests that drinking coffee is not harmful and may potentially be beneficial," says Dana-Farber's Dr Kimmie Ng, senior author of the study.
"This study adds to the large body of literature supporting the importance of diet and other modifiable factors in the treatment of patients with colorectal cancer," Ng adds. "Further research is needed to determine if there is indeed a causal connection between coffee consumption and improved outcomes in patients with colorectal cancer, and precisely which compounds within coffee are responsible for this benefit."
Importance: Several compounds found in coffee possess antioxidant, anti-inflammatory, and insulin-sensitizing effects, which may contribute to anticancer activity. Epidemiological studies have identified associations between increased coffee consumption and decreased recurrence and mortality of colorectal cancer. The association between coffee consumption and survival in patients with advanced or metastatic colorectal cancer is unknown.
Objective: To evaluate the association of coffee consumption with disease progression and death in patients with advanced or metastatic colorectal cancer.
Design, Setting, and Participants: This prospective observational cohort study included 1171 patients with previously untreated locally advanced or metastatic colorectal cancer who were enrolled in Cancer and Leukemia Group B (Alliance)/SWOG 80405, a completed phase 3 clinical trial comparing the addition of cetuximab and/or bevacizumab to standard chemotherapy. Patients reported dietary intake using a semiquantitative food frequency questionnaire at the time of enrollment. Data were collected from October 27, 2005, to January 18, 2018, and analyzed from May 1 to August 31, 2018.
Exposures: Consumption of total, decaffeinated, and caffeinated coffee measured in cups per day.
Main Outcomes and Measures: Overall survival (OS) and progression-free survival (PFS).
Results: Among the 1171 patients included in the analysis (694 men [59%]; median age, 59 [interquartile range, 51-67] years). The median follow-up time among living patients was 5.4 years (10th percentile, 1.3 years; IQR, 3.2-6.3 years). A total of 1092 patients (93%) had died or had disease progression. Increased consumption of coffee was associated with decreased risk of cancer progression (hazard ratio [HR] for 1-cup/d increment, 0.95; 95% CI, 0.91-1.00; P = .04 for trend) and death (HR for 1-cup/d increment, 0.93; 95% CI, 0.89-0.98; P = .004 for trend). Participants who consumed 2 to 3 cups of coffee per day had a multivariable HR for OS of 0.82 (95% CI, 0.67-1.00) and for PFS of 0.82 (95% CI, 0.68-0.99), compared with those who did not drink coffee. Participants who consumed at least 4 cups of coffee per day had a multivariable HR for OS of 0.64 (95% CI, 0.46-0.87) and for PFS of 0.78 (95% CI, 0.59-1.05). Significant associations were noted for both caffeinated and decaffeinated coffee.
Conclusions and Relevance: Coffee consumption may be associated with reduced risk of disease progression and death in patients with advanced or metastatic colorectal cancer. Further research is warranted to elucidate underlying biological mechanisms.
Christopher Mackintosh, Chen Yuan, Fang-Shu Ou, Sui Zhang, Donna Niedzwiecki, I-Wen Chang, Bert H O’Neil, Brian C Mullen, Heinz-Josef Lenz, Charles D Blanke, Alan P Venook, Robert J Mayer, Charles S Fuchs, Federico Innocenti, Andrew B Nixon, Richard M Goldberg, Eileen M O’Reilly, Jeffrey A. Meyerhardt, Kimmie Ng
Dana-Farber Cancer Institute material
JAMA Oncology abstract
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