A daily low-dose aspirin may cut colorectal cancer recurrence in patients with PI3K pathway mutations, present in about one-third of cases. The ALASCCA trial found that 160 mg of aspirin daily for three years reduced recurrence risk by 55% versus placebo, benefiting patients across different PI3K gene alterations (PIK3CA, PIK3R1, PTEN) and cancer stages.
Aspirin likely works by disrupting the mutated PI3K signaling pathway, reducing inflammation, and inhibiting platelets that protect cancer cells. This mechanism highlights its potential as a targeted, inexpensive adjuvant therapy.
These results suggest genetic testing could identify patients most likely to benefit. However, aspirin carries risks, including bleeding, so use should be guided by a physician after weighing individual risks and benefits. This study represents a step toward precision medicine in colorectal cancer prevention.