Imagine popping an over-the-counter pill to remedy a headache. Or taking the same to treat inflammation or arthritis. And all the while, the same common pill is working to cut the risk of colon cancer recurrence by half!A major new study is pointing in that direction. The study in question has brought hope to many affected by colorectal cancer: a simple, widely available over-the-counter pill appears to cut the chance of recurrence in half – at least for some patients. Researchers say that for those whose tumors carry specific mutations in the PI3K signaling pathway, taking that drug daily in low dosage after surgery can lead to dramatically better outcomes.
What drug is it? And what does the study say?Read on to know more.
What did the study find
A large randomized clinical trial called ALASCCA (led by a research team at Karolinska Institutet and Karolinska University Hospital in Sweden), published in The New England Journal of Medicine, shows that patients with colorectal cancer who have specific mutations in the PI3K signalling pathway can reduce their risk of cancer recurrence by about 55% if they take 160 mg of aspirin daily for three years after surgery.The trial involved 3,508 patients who had undergone surgery for colon or rectal cancer (stages I-III or II-III depending on site) across 33 hospitals in Sweden, Norway, Denmark, and Finland. Genetic testing was done on all tumours to identify mutations in the PI3K signalling pathway (including PIK3CA, PIK3R1, and PTEN genes). Roughly 37-40% of patients were found to have such mutations. Among those with the mutation, participants were randomised: one group received 160 mg of aspirin daily; the other received a placebo. This continued for three years. For them, aspirin reduced recurrence dramatically versus those on placebo.
Why the PI3K pathway matters
The PI3K (phosphoinositide 3-kinase) pathway helps control cell growth and survival. Mutations in PI3K can lead to overactive signalling, which cancers exploit to grow, resist death, or come back after treatment. When aspirin interferes with inflammation, platelet activity, and possibly this mutated pathway, it seems to reduce the chance that leftover cancer cells will re-grow or metastasize.In the aforementioned study, for patients with PI3K pathway alterations, the rate of cancer recurrence over three years was substantially lower in the aspirin group compared to placebo, about a 55% reduction in recurrence risk. More importantly, the benefit was seen across several factors: colon vs rectal cancer, different stages (I-III or II-III), male and female patients.So, who can benefit?Those whose tumours have PI3K alterations (roughly a third of patients) and patients who have had their tumour surgically removed (stage I-III colon or stage II-III rectal cancer).It’s important to note that all the participants were under 80 years old in this trial, as patients over 80 were not included.
How aspirin may work
Researchers believe several mechanisms may contribute:Aspirin is an anti-inflammatory drug; it can reduce inflammation, which is known to support tumour-regrowth or recurrence.It inhibits platelet function. Platelets can protect tiny tumour fragments or circulating tumour cells, so interfering with them helps the immune system act against them.The genetic mutation in the PI3K pathway seems to make tumour cells more vulnerable to aspirin’s effects. This is an example of precision medicine: matching treatment to genetic profile.
Side effects and potential risks
Aspirin, although it has proven to be beneficial, is not risk-free. Some participants experienced serious adverse events (though only a few): gastrointestinal bleeding, allergic reactions, or other bleeding events. In particular, aspirin can aggravate stomach ulcers, weak bleeding disorders, etc. There was also one death possibly associated with aspirin.Doctors emphasize that aspirin should only be used under medical supervision, particularly after weighing risks vs benefits for each individual.
What’s ahead
Colorectal cancer is one of the more common cancers worldwide. It’s a type of cancer that develops in the tissues of the colon or rectum. It starts in the large intestine (colon) and often develops from small, noncancerous clumps of cells called polyps. It’s the second leading cause of cancer death in the United States.Every year, nearly two million people worldwide are diagnosed with colorectal cancer. Between 20 and 40% develop metastases, which makes the disease both more difficult to treat and more deadly. Even after successful surgery, there is a risk of recurrence. Reducing that risk is a major goal in cancer research.
This new research suggests that a low, daily dose of aspirin could cut the recurrence risk of colorectal cancer by about half in patients with PI3K pathway mutations, over three years after surgery. It points toward personalized cancer treatment, where simple drugs combined with genetic testing may improve long-term outcomes.Thanks to this study, routine genetic testing for PI3K pathway mutations may become part of standard care for patients after colorectal cancer surgery. Those who test positive could be offered daily low-dose aspirin as part of their adjuvant therapy. And because aspirin is cheap, globally available, and well understood, this could be a cost-effective and affordable strategy, particularly in lower-resource settings.However, a longer follow-up is needed to see whether these benefits also translate into overall survival gains (not just recurrence rate).
