Can Low-Dose Aspirin Reduce Colorectal Cancer Recurrence?
The benefits of low-dose aspirin have been debated for years, particularly regarding its role in reducing coronary disease. However, its potential in preventing and managing colorectal cancer (CRC) has gained significant attention. A recent study found that low-dose aspirin reduced CRC recurrence by over 50% in patients whose tumors harbored mutations in the PI3K signaling pathway. These findings underscore the critical importance of upfront genomic testing for CRC patients.
This is the first trial to demonstrate that PI3K pathway mutations predict aspirin response, significantly expanding the targetable patient population—given that approximately 30% of CRCs carry these mutations. While aspirin’s potential as a chemopreventive agent for CRC has been explored, definitive data confirming its effectiveness and its adoption in clinical practice have been lacking until now.
The study included 626 patients (median age: 66 years; 52% women) with stage II–III colon cancer (67%) or stage I–III rectal cancer (33%) across 33 hospitals in Sweden, Denmark, Finland, and Norway. Patients were stratified based on specific PI3K pathway alterations and randomly assigned to receive either aspirin (160 mg daily) or a placebo for three years.
The primary outcome was CRC recurrence, with disease-free survival as a secondary endpoint. In patients with PIK3CA mutations, aspirin reduced the risk of recurrence by 51%, with a three-year recurrence rate of 7.7% in the aspirin group compared to 14.1% in the placebo group. The benefit of aspirin was consistent across all subgroups, including men and women, those with colon or rectal cancer, patients who received neoadjuvant or adjuvant treatment, and those with stage I, II, or III disease.
This study reinforces the need to integrate genomic marker data into clinical registries to guide personalized treatment strategies that can effectively reduce cancer recurrence.
