Authors
Tamotsu Sagawa, Masahiro Hirakawa, Hiroyuki Nagashima, Koshi Fujikawa
Published in
Journal of gastrointestinal cancer. Volume 57. Issue 1. Nov 11, 2026. Epub Nov 11, 2026.
Abstract
Postoperative aspirin has produced inconsistent results in molecularly unselected colorectal cancer, whereas ALASCCA supports a biomarker-selected strategy. We synthesize randomized, molecular, and mechanistic evidence and propose a cautious framework for clinical consideration.
This clinically oriented narrative review searched PubMed/MEDLINE, ClinicalTrials.gov, jRCT, PROSPERO, ASCO and ESMO materials, and reference lists, with a final update on September 27, 2026. Randomized trials and prospective biomarker-selected evidence were prioritized.
ASCOLT and EPISODE-III/JCOG1503C did not meet their primary disease-free survival endpoints in unselected populations. SAKK 41/13 was underpowered but directionally supportive. In ALASCCA, aspirin 160 mg daily for 3 years reduced 3-year colorectal cancer recurrence in group A PIK3CA exon 9/20 hotspot tumors (7.7% vs. 14.1%; HR 0.49, 95% CI 0.24-0.98). Group B showed a favorable estimate (7.7% vs. 16.8%; HR 0.42, 95% CI 0.21-0.83) but was secondary and molecularly heterogeneous. Low-dose platelet COX-1/thromboxane inhibition is pharmacologically established; direct tumor-cell COX-2/PI3K effects remain less certain. Mature overall-survival data are lacking.
Adjuvant aspirin should not be used universally after colorectal cancer resection. The strongest evidence applies to ALASCCA group A, while group B requires variant-level caution. Any use should preserve standard adjuvant therapy and incorporate bleeding risk, local guidance, and shared decision-making.
PMID:
43013199
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.
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