Understanding the Role of Aspirin in Colorectal Cancer

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Adjuvant treatment with aspirin seems to reduce the risk of recurrence in patients with colorectal cancer (CRC), according to emerging data. Furthermore, Axel Grothey, MD, notes, treatment with aspirin also affects the number of polyps that manifest in patients with familial adenomatous polyposis.

In general, Grothey notes, the evidence supporting aspirin is overwhelmingly positive, suggesting that COX-2 inhibitors can reduce recurrence in CRC. Moreover, research has tied aspirin’s efficacy to mutations in the PIK3CA gene. In ways, Grothey notes, aspirin works as a targeted agent for patients with PIK3CA mutations. As a result, more potent COX-2 inhibitors, such as celecoxib, are being examined in randomized trials in adjuvant CRC.

Heinz-Josef Lenz, MD, believes that PI3K testing should be performed more routinely, as it provides insight into the risk for recurrence. However, if a patient does not test positive for PIKC3A, Lenz does not feel that discontinuing treatment with aspirin is necessary. Overall, more data on markers of recurrence are needed but preliminary data regarding aspirin has been promising.