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Aspirin doesn't help — and may hurt — after colorectal cancer liver surgery. A phase 3 trial found that daily aspirin after curative-intent treatment of colorectal cancer (CRC) liver metastases did not improve disease-free survival and was linked to worse overall survival compared to placebo. The findings argue against routine aspirin use in this setting.
Aspirin doesn't help — and may hurt — after colorectal cancer liver surgery
A large phase 3 trial has delivered a clear verdict: adjuvant aspirin does not improve outcomes for patients who have undergone curative-intent treatment for colorectal cancer (CRC) liver metastases. The ASAC trial, published in The Lancet Gastroenterology & Hepatology, enrolled 428 adults across Norway, Sweden, and Denmark who were randomized to receive either 160 mg aspirin or placebo daily for up to 3 years post-surgery.
Not only did aspirin fail to extend disease-free survival, but patients in the aspirin arm also had a notably lower overall survival rate at 36 months compared to those on placebo. Serious adverse events were also far more common in the aspirin group, including myocardial infarction, cerebral hemorrhage, and duodenal ulcers.
By the Numbers
Why it matters: These results challenge earlier hopes that aspirin's anti-cancer properties — particularly in PIK3CA-mutated tumors — could benefit CRC patients post-resection. Clinicians should not routinely recommend adjuvant aspirin in this context, as it offers no survival benefit and carries meaningful safety risks.
