Dr Atsuo Takashima speaks to ecancer about the phase III EPISODE-III trial which evaluated whether adding low-dose aspirin to standard adjuvant chemotherapy improves outcomes in patients with stage III colorectal cancer (CRC).

Results showed that aspirin led to a numerical improvement in 3-year disease-free survival (78.8% vs 75.4%), but this did not reach statistical significance, meaning the primary endpoint was not met.

Overall survival and relapse-free survival were also similar between treatment arms.

Importantly, aspirin was well tolerated, with very low rates of serious treatment-related adverse events and minimal increase in bleeding risk.

While these findings do not support routine use of aspirin in an unselected population, the observed trend toward benefit and ongoing biomarker analyses (e.g., PI3K/PIK3CA mutations) may help identify subgroups of patients who could benefit from this low-cost, widely available therapy.