A phase 3 clinical trial demonstrated that low-dose aspirin significantly reduced colorectal cancer recurrence rates by more than half in patients with tumors carrying mutations in the PI3K signaling pathway. This finding highlights the importance of genomic testing for CRC patients and the potential of aspirin as a targeted treatment.
Low-dose aspirin significantly reduced colorectal cancer (CRC) recurrence rates in patients with tumors carrying mutations in the PI3K signaling pathway, according to the results of the phase 3 ALASCCA trial. This finding underscores the crucial role of upfront genomic testing in CRC patients, as reported by Dr. Anna Martling, MD, PhD, from Karolinska Institutet in Stockholm, Sweden, during the American Society of Clinical Oncology (ASCO) conference.Dr.
Martling highlighted that identifying these genetic mutations, which are present in approximately 30% of CRCs, can predict aspirin's effectiveness, potentially expanding the pool of eligible patients for this treatment approach considerably. While aspirin's potential as a chemoprevention agent in CRC has been explored previously, concrete data confirming its efficacy and widespread adoption in clinical practice have been lacking, as explained by ASCO expert Dr. Pamela Kunz, MD, from Smilow Cancer Hospital and Yale Cancer Center in New Haven, Connecticut. Dr. Kunz emphasized that the study's findings are truly practice-changing, as they demonstrate a multifaceted approach that is effective, low-risk, cost-efficient, and easy to administer.The trial involved 626 patients (median age 66 years; 52% women) diagnosed with stages II-III colon cancer (67%) or stages I-III rectal cancer (33%) across 33 hospitals in Sweden, Denmark, Finland, and Norway. Participants in both groups were randomly assigned 1:1 to receive either 160 mg/d of aspirin or a placebo for a period of 3 years. The primary outcome assessed was CRC recurrence, while disease-free survival served as a secondary outcome. The study revealed that low-dose aspirin significantly reduced CRC recurrence rates. In patients with PI3K pathway mutations (Group B), the effect was particularly pronounced. This group experienced a 58% lower risk of recurrence compared to the placebo group, with a 3-year recurrence rate of 7.7% in the aspirin group versus 16.8% in the placebo group. Aspirin also conferred a disease-free survival benefit in both groups, although this was statistically significant only in Group B. While the study wasn't primarily designed for subgroup analysis, the benefits of aspirin were observed across all examined subgroups, including men and women with colon or rectal cancer, individuals who did and did not receive neoadjuvant or adjuvant treatment, and those with stages I, II, and III disease. The incidence of adverse events was consistent with expectations, and severe side effects associated with 160 mg/d aspirin were rare, according to Dr. Martling. Both Dr. Martling and Dr. Kunz anticipate that these findings will significantly impact clinical practice. Dr. Kunz predicts widespread adoption of this practice-changing approach
COLORECTAL CANCER ASPIRIN GENOMIC TESTING PI3K MUTATIONS RECURRENCE RATES
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