Aspirin cuts colorectal cancer recurrence risk by half in individuals with certain genetic markers among high risk individuals

Good news! Cancer is history (soon)! This was a three year long study!

Good old Aspirin keeps on giving! I take one baby/low dose Aspirin (81 mg) pill basically every day since about the year 1999. My last colonoscopy did find anything.

"A study involving more than 1,000 cancer patients has found that a low dose of aspirin halves the risk of colorectal tumors returning after surgery. This readily available and inexpensive treatment could change health outcomes for a significant number of cancer survivors who have problematic gene variants. ...

Researchers ... screened 3,508 patients with stage I, II, or III rectal cancer or stage II or III colon cancer, finding that 1,103 of these people had a specific variant in the PI3K pathway – the genetic marker of interest. The team then conducted a double-blind, randomized, placebo-controlled trial on this gene-altered cohort, with 626 patients receiving 160-mg aspirin daily for three years and the remainder taking a placebo.

This study, known as the ALASCCA trial, was a massive effort involving 33 hospitals in Sweden, Norway, Denmark and Finland. The team prioritized people with the PIK3CA gene mutation, as well as people with other moderate or high impact variants in PIK3R1 and PTEN. ...

What they found was that for people with the genetic mutation in PIK3, aspirin lowered the risk of recurrence by 55% compared with placebo treatment. ..."

From the abstract:

"Background

Aspirin reduces the incidence of colorectal adenoma and colorectal cancer among high-risk persons. Observational studies suggest that aspirin may also improve disease-free survival after diagnosis, particularly among patients with tumors harboring somatic PIK3CA mutations. However, data from randomized trials are lacking.

Methods

We conducted a double-blind, randomized, placebo-controlled trial involving patients with stage I, II, or III rectal cancer or stage II or III colon cancer with somatic alterations in PI3K pathway genes. The patients were assigned in a 1:1 ratio to receive 160 mg of aspirin or matched placebo once daily for 3 years. Patients with prespecified PIK3CA hotspot mutations in exon 9 or 20 (group A alterations) and those with other moderate- or high-impact somatic variants in PIK3CA, PIK3R1, or PTEN (group B alterations) were eligible for randomization. The primary endpoint was colorectal cancer recurrence, assessed in a time-to-event analysis, in patients with group A alterations. Secondary end points included colorectal cancer recurrence in patients with group B alterations, disease-free survival, and safety.

Research Summary

Results

Alterations in PI3K pathway genes were detected in 1103 of 2980 patients (37.0%) with complete genomic data.

Of 515 patients with group A alterations and 588 patients with group B alterations, 314 and 312, respectively, were assigned to receive aspirin or placebo.

The estimated 3-year cumulative incidence of recurrence was 7.7% with aspirin and 14.1% with placebo (hazard ratio, 0.49; 95% confidence interval [CI], 0.24 to 0.98; P=0.04) among patients with group A alterations and 7.7% and 16.8%, respectively (hazard ratio, 0.42; 95% CI, 0.21 to 0.83), among those with group B alterations.

The estimated 3-year disease-free survival was 88.5% with aspirin and 81.4% with placebo (hazard ratio, 0.61; 95% CI, 0.34 to 1.08) among patients with group A alterations and 89.1% and 78.7%, respectively (hazard ratio, 0.51; 95% CI, 0.29 to 0.88), among those with group B alterations. 

Severe adverse events occurred in 16.8% of aspirin recipients and 11.6% of placebo recipients.

Conclusions

Aspirin led to a significantly lower incidence of colorectal cancer recurrence than placebo among patients with PIK3CA hotspot mutations in exon 9 or 20 and appeared to have a similar benefit among those with other somatic alterations in PI3K pathway genes. ..."

Aspirin cuts colorectal cancer recurrence risk by half

Common inexpensive drug halves recurrence in colorectal cancer (original news release) "A Swedish-led research team at Karolinska Institutet and Karolinska University Hospital has shown in a new randomized clinical trial that a low dose of the well-known medicine aspirin halves the risk of recurrence after surgery in patients with colon and rectal cancer with a certain type of genetic alteration in the tumor."

Low-Dose Aspirin for PI3K-Altered Localized Colorectal Cancer (no public access)