{"entity":{"id":"idea-reg-aspirin-pik3ca-implementation","kind":"idea","name":"Get biomarker-directed aspirin after colorectal surgery into labels and guidelines","aka":[],"tldr":"A Swedish trial found that cheap aspirin roughly halved recurrence in colorectal cancer patients with a particular tumour mutation. Nobody is going to market it, so health systems must adopt it deliberately.","summary":"The ALASCCA randomised trial (reported 2025) found that low-dose aspirin for three years reduced recurrence in patients with PIK3CA-mutated colorectal cancer after surgery, following earlier observational signals, while broader trials (ASCOLT, Add-Aspirin ongoing) have shown smaller or no unselected effects. Because aspirin has no sponsor, the result risks slow and uneven adoption. The proposal is a coordinated implementation programme: guideline inclusion (ESMO, NCCN), routine PIK3CA testing at diagnosis as a reimbursed test, third-party label filings where pathways exist, and an implementation registry capturing uptake and outcomes.","asOf":"2026-09-08","links":[{"label":"ALASCCA trial, NEJM 2025","url":"https://www.nejm.org/doi/full/10.1056/NEJMoa2504650"}],"tags":[],"related":[],"cancers":["colorectal"],"sections":[],"technologies":[],"targets":["pik3ca"],"drugs":[],"companies":[],"institutions":["karolinska","esmo"],"pathways":["pi3k-akt-mtor"],"terms":[],"trials":[],"people":[],"bottlenecks":["b-generic-repurposing","b-knowledge-diffusion"],"keyPapers":["paper-pik3ca-colorectal-lancet-oncol-2011","paper-pik3ca-colorectal-acta-oncol-2014","paper-pik3ca-colorectal-j-clin-oncol-2013"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Within three years, more than 70% of eligible PIK3CA-mutated colorectal cancer patients in participating health systems receive adjuvant aspirin, and registry data confirm a recurrence reduction consistent with the trial.","rationale":"A proven, near-free intervention that reduces recurrence in a common cancer is exactly the case where the absence of a commercial sponsor costs lives; the barrier is testing infrastructure and awareness, both of which implementation programmes address.","test":"Audit PIK3CA testing and aspirin prescribing rates in five health systems, run an implementation intervention in half of them, and compare uptake and 3-year recurrence.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-reg-aspirin-pik3ca-implementation/","neighbours":{"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"target":[{"id":"pik3ca","kind":"target","name":"PIK3CA / PI3K-alpha","route":"/targets/pik3ca/"}],"institution":[{"id":"esmo","kind":"institution","name":"European Society for Medical Oncology (ESMO)","route":"/institutions/esmo/"},{"id":"karolinska","kind":"institution","name":"Karolinska University Hospital","route":"/institutions/karolinska/"}],"pathway":[{"id":"pi3k-akt-mtor","kind":"pathway","name":"PI3K / AKT / mTOR","route":"/pathways/pi3k-akt-mtor/"}],"bottleneck":[{"id":"b-knowledge-diffusion","kind":"bottleneck","name":"Knowledge reaches practice too slowly","route":"/bottlenecks/b-knowledge-diffusion/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"}],"paper":[{"id":"paper-capp2-aspirin-lynch-lancet-2020","kind":"paper","name":"CAPP2: two years of aspirin cuts bowel cancer in Lynch syndrome by more than a third over 10 years","route":"/key-papers/paper-capp2-aspirin-lynch-lancet-2020/"},{"id":"paper-pik3ca-colorectal-j-clin-oncol-2013","kind":"paper","name":"Evaluation of PIK3CA mutation as a predictor of benefit from nonsteroidal anti-inflammatory drug therapy in colorectal cancer","route":"/key-papers/paper-pik3ca-colorectal-j-clin-oncol-2013/"},{"id":"paper-pik3ca-colorectal-lancet-oncol-2011","kind":"paper","name":"KRAS, BRAF, PIK3CA, and PTEN mutations: implications for targeted therapies in metastatic colorectal cancer","route":"/key-papers/paper-pik3ca-colorectal-lancet-oncol-2011/"},{"id":"paper-pik3ca-colorectal-acta-oncol-2014","kind":"paper","name":"The predictive value of KRAS, NRAS, BRAF, PIK3CA and PTEN for anti-EGFR treatment in metastatic colorectal cancer: A systematic review and meta-analysis","route":"/key-papers/paper-pik3ca-colorectal-acta-oncol-2014/"}],"technology":[{"id":"aspirin-cancer-prevention","kind":"technology","name":"Aspirin for cancer prevention and adjuvant therapy","route":"/technologies/aspirin-cancer-prevention/"}],"trial":[{"id":"alascca","kind":"trial","name":"ALASCCA","route":"/trials/alascca/"}],"roadmap":[{"id":"prevention-roadmap","kind":"roadmap","name":"Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers","route":"/roadmaps/prevention-roadmap/"}]}}