Aspirin after curative-intent treatment of colorectal cancer liver metastases (ASAC): a multicentre, phase 3, randomised, double-blind, placebo-controlled trial.
Sheraz Yaqub, Morten Valberg, Bjørn Atle Bjørnbeth et al.
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In 30 seconds
The ASAC phase 3, multicentre, randomised, double-blind, placebo-controlled trial tested aspirin 160 mg daily after curative-intent treatment of colorectal cancer liver metastases. Among 428 patients who initiated treatment, aspirin for up to 3 years did not improve disease-free survival compared with placebo (hazard ratio for recurrence or death 1·08 [95·44% CI 0·85-1·38]; p=0·51). Overall survival at 36 months was lower in the aspirin group, and serious adverse events were more frequent. The findings do not support routine adjuvant aspirin in this setting.
Key findings
- Disease-free survival did not improve with aspirin: HR for recurrence or death 1·08 [95·44% CI 0·85-1·38]; p=0·51.
- Overall survival at 36 months was 76% with aspirin and 85% with placebo (HR for death 1·64 [95% CI 1·01-2·65]; p=0·045).
- Serious adverse events occurred in 17 (8%) of 217 aspirin recipients and four (2%) of 211 placebo recipients.
Why it matters
Recurrence after curative-intent treatment of colorectal liver metastases is common, making adjuvant strategies clinically important. In this randomised trial, aspirin did not improve the primary disease-free survival outcome, while overall survival was lower and serious adverse events more frequent in the aspirin group. These results caution against assuming that aspirin’s preventive effects in other colorectal cancer contexts extend to treated metastatic disease.
What to keep in mind
The findings apply to patients who initiated study treatment and may not generalise beyond the trial population and setting. The abstract does not provide further detail on follow-up or subgroup effects.