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A Nordic trial showing that three years of low-dose aspirin roughly halves recurrence in bowel cancers carrying a particular set of mutations, a biomarker-directed use of a drug that costs pennies.
3,508 patients were screened for tumour PIK3CA and PI3K-pathway alterations; 626 with alterations were randomised. In group A (PIK3CA exon 9 or 20 hotspot mutations, n=314) recurrence at three years was 7.7% with aspirin vs 14.1% with placebo (HR 0.49, 95% CI 0.24-0.98); in group B (other PIK3CA mutations or PIK3R1/PTEN alterations, n=312) it was 7.7% vs 16.8% (HR 0.42, 95% CI 0.21-0.83). Severe adverse events attributable to aspirin were uncommon (about 2%). ALASCCA validates a decade of observational data from the Nurses' Health Study and CALGB 89803 suggesting PIK3CA-mutant tumours are aspirin-sensitive, and creates an implementation task: routine PIK3CA testing in early colorectal cancer, which most pathology services do not currently perform.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
626 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Time to recurrence at 3 years, group A (PIK3CA exon 9/20)primary | Aspirin | - | 7.7% | 0.49 (0.24 to 0.98) | - | link |
| Placebo | - | 14.1% | ||||
| Time to recurrence at 3 years, group B (other PI3K-pathway alterations) | Aspirin | - | 7.7% | 0.42 (0.21 to 0.83) | - | link |
| Placebo | - | 16.8% |
Shares Systematic drug repurposing, Aspirin, Aspirin for cancer prevention and adjuvant therapy, Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers.
Shares Get biomarker-directed aspirin after colorectal surgery into labels and guidelines, Aspirin, Germline vs somatic mutations, No incentive to repurpose cheap drugs.
Shares Aspirin, Aspirin for cancer prevention and adjuvant therapy, Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers.
Shares Aspirin for cancer prevention and adjuvant therapy, Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers, Colorectal cancer.
Shares Aspirin, Aspirin for cancer prevention and adjuvant therapy.
Shares Systematic drug repurposing, No incentive to repurpose cheap drugs.
Shares Aspirin for cancer prevention and adjuvant therapy, No incentive to repurpose cheap drugs, Colorectal cancer.