Meta-analysis of five randomized trials involving 7,246 postoperative colorectal cancer patients demonstrates that anti-inflammatory medications reduce disease recurrence by 15% overall, with aspirin showing particularly strong effects—cutting recurrence risk by 30%. The most striking finding emerged in patients carrying PI3K pathway mutations, who experienced a 44% reduction in recurrence risk when treated with these agents.
This data strengthens the biological rationale linking chronic inflammation to cancer progression through COX-2 and prostaglandin pathways. The PI3K mutation finding is especially significant because it suggests a precision medicine approach where genetic profiling could identify patients most likely to benefit from adjuvant anti-inflammatory therapy. Previous observational studies hinted at these benefits, but this represents the most robust randomized evidence to date.
The safety profile proved reassuring, with no increased rates of cardiac events, gastrointestinal bleeding, or infections—historically the main concerns with long-term NSAID use in cancer survivors. However, the analysis showed improvement in disease-free survival rather than overall survival, indicating the therapy delays rather than prevents fatal recurrence. For the estimated 150,000 Americans diagnosed with colorectal cancer annually, particularly those with high-risk genetic profiles, this could represent a low-cost adjuvant strategy worth discussing with oncologists.