A groundbreaking study presented at the 2025 ASCO Gastrointestinal Cancer Symposium revealed that aspirin could significantly reduce the risk of colorectal cancer recurrence in patients with PIK3CA mutations. The three-year results from the ALASCCA trial (NCT02647099) demonstrated a 50% reduction in recurrence risk compared to placebo.
"Our findings expand the target population to more than a third of non-metastasized colorectal cancer patients," said Anna Martling, MD, PhD, FACS, FASCRS, from Karolinska Institutet, Lund University, and Akademiska University Hospital, who presented the results. "This is an exciting example of repurposing a safe, inexpensive, and globally available drug like aspirin, and it underscores the importance of genomic testing in colorectal cancer patients."
The randomized, placebo-controlled trial met its primary endpoint, demonstrating a 51% risk reduction in patients with PIK3CA exons 9/20 (Group A) and 58% in patients with PIK3R1/PTEN/other PIK3CA alterations (Group B) who took aspirin for three years. Notably, aspirin also improved disease-free survival (DFS) in Group B by 49%.
Martling highlighted the wide-ranging benefits of aspirin across various subgroups, including patients with colon or rectal cancer, those who had undergone neoadjuvant or adjuvant treatment, and across different stages and genders. Aspirin was well-tolerated, with a similar incidence of severe adverse events in the aspirin and placebo arms.
This landmark study builds on existing evidence that aspirin can prevent colonic polyps, lower colorectal cancer incidence, and potentially improve DFS. It also supports the hypothesis that PIK3CA mutations may predict aspirin's treatment effect. Could aspirin soon be repurposed to prevent recurrence in early-stage colorectal cancer? Only time, and further research, will tell.