OnCo
ideasIdea

Get biomarker-directed aspirin after colorectal surgery into labels and guidelines

A Swedish trial found that cheap aspirin roughly halved recurrence in colorectal cancer patients with a particular tumour mutation. Nobody is going to market it, so health systems must adopt it deliberately.

The ALASCCA randomised trial (reported 2025) found that low-dose aspirin for three years reduced recurrence in patients with PIK3CA-mutated colorectal cancer after surgery, following earlier observational signals, while broader trials (ASCOLT, Add-Aspirin ongoing) have shown smaller or no unselected effects. Because aspirin has no sponsor, the result risks slow and uneven adoption. The proposal is a coordinated implementation programme: guideline inclusion (ESMO, NCCN), routine PIK3CA testing at diagnosis as a reimbursed test, third-party label filings where pathways exist, and an implementation registry capturing uptake and outcomes.

Hypothesis
Within three years, more than 70% of eligible PIK3CA-mutated colorectal cancer patients in participating health systems receive adjuvant aspirin, and registry data confirm a recurrence reduction consistent with the trial.
Rationale
A proven, near-free intervention that reduces recurrence in a common cancer is exactly the case where the absence of a commercial sponsor costs lives; the barrier is testing infrastructure and awareness, both of which implementation programmes address.
What would test it
Audit PIK3CA testing and aspirin prescribing rates in five health systems, run an implementation intervention in half of them, and compare uptake and 3-year recurrence.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks

Key papers

1top

Connected

10top

Pages like this

not linked directly; found by shared links