Year of Grant: 2015

Location: Singapore

Colorectal cancer (CRC) is the third most common cancer globally, both in incidence and mortality, with more than 1.3 million new cases and 670,000 annual deaths respectively. The incidence rates from CRC are on the raise with no sign of abatement. The standard of care for resected stage 2 or 3 CRC consists of chemotherapy and sometimes targeted agents, which are expensive and often fail to improve survival outcomes.

In the past decade, there has been an emergence of strong indirect evidence supporting aspirin’s role in reducing cancer metastasis, post-surgical CRC recurrence and CRC-specific death. Observational studies strongly suggest that aspirin treatment initiated after the diagnosis, nearly halves the risk of colorectal cancer deaths. This body of evidence though extremely compelling, is still based on observational results rather than formal experiment testing in randomized prospective clinical trials required to change clinical practice guidelines.

An international collaboration led by researchers in Singapore, UK and Australia, this clinical trial is the first proactive study to address the role of aspirin in cancer and involves 50 sites in 11 countries across Asia. Its primary goal is to assess the effectiveness of daily aspirin against placebo control in stage 2 and 3 patients. The proposed study intervention is aspirin 200mg versus placebo 200mg daily. Patients will be treated for the duration of 3 years, and will be followed up for an additional 2 years (total of 5 years).

If positive, the trial would lead to the change of clinical practice guidelines, which could potentially save thousands of lives in both the developing and developed countries. Since aspirin costs a penny a pill, it could also represent a highly cost-effective way of further reducing cancer recurrence risk, over and above chemotherapy.