A phase 3 trial published in the New England Journal of Medicine demonstrated that 3 years of aspirin use significantly lowered recurrence risk in colorectal cancer patients with PIK3CA mutations.
The ALASCCA trial demonstrated a 51% reduction in recurrence risk for patients with PIK3CA exon 9/20 mutations and a 58% reduction for those with PIK3R1/PTEN/other PIK3CA alterations with aspirin use for 3 years. This study also suggested that aspirin’s benefits extend beyond PIK3CA mutations, potentially helping up to 40% of colorectal cancer patients.
Researchers studied changes in certain genes in the PI3K pathway, which are linked to how cancer grows and responds to treatment. These changes were found in about 37% of nearly 3,000 patients tested. Patients with these gene changes were divided into two groups (called group A and group B) and then randomly given either aspirin or a placebo (a pill with no medicine).
Key Findings
- In both groups, patients who received aspirin had a lower risk of their cancer coming back compared to those who received placebo.
- Group A: The chance of recurrence over 3 years was about 8% with aspirin vs. 14% with placebo.
- Group B: The chance of recurrence over 3 years was about 8% with aspirin vs. 17% with placebo.
- Patients taking aspirin also had better 3-year disease-free survival, meaning they lived longer without their cancer returning.
- Group A: 89% with aspirin vs. 81% with placebo.
- Group B: 89% with aspirin vs. 79% with placebo.
Side Effects
- Serious side effects occurred in 17% of patients on aspirin compared to 12% on placebo.
This study suggests that aspirin may help prevent cancer from coming back in patients with certain gene changes, although it also carries some additional risk of side effects.
The findings highlight the potential of repurposing aspirin, an inexpensive and widely available drug, for colorectal cancer treatment and underscore the importance of genomic testing in patient care.
This groundbreaking research opens new possibilities for colorectal cancer treatment, potentially offering a cost-effective and accessible option for a significant portion of patients with specific genetic mutations. Talk to your oncologist about how new developments like this might affect your treatment plan and whether genomic testing is appropriate for you.
More Reading
Ask the Experts About Circulating Tumor DNA in the Management of Colorectal Cancer
References
Martling A, Lindberg J, Myrberg IH, et al. Low-dose aspirin to reduce recurrence rate in colorectal cancer patients with PI3K pathway alterations: 3-year results from a randomized placebo-controlled trial. J Clin Oncol. 2025;43(4):LBA125.
Liao X, Lochhead P, Nishihara R, et al. Aspirin use, tumor PIK3CA mutation, and colorectal-cancer survival. N Eng J Med. 2012;367(17):1596-606. doi:10.1056/NEJMoa1207756.
