The ALASCCA study investigated the efficacy of low-dose aspirin in patients with colorectal cancer with mutations in the PIK3CA gene after surgery.[1] The results showed that aspirin significantly reduced the risk of disease recurrence: in patients with group A mutations, the three-year cumulative incidence of recurrence was 7.7% with aspirin compared with 14.1% with placebo (hazard ratio 0.49).[1] Similarly, in patients with group B alterations, the incidence of recurrence was 7.7% with aspirin and 16.8% with placebo (hazard ratio 0.42).[1] Three-year disease-free survival was higher with aspirin: 88.5% versus 81.4% in group A and 89.1% versus 78.7% in group B.[1] Serious adverse events occurred in 16.8% of patients taking aspirin and 11.6% of patients in the placebo group, primarily related to bleeding and gastrointestinal toxicity.[1] Based on these findings, new NCCN clinical guidelines (2025) recommend considering PIK3CA testing in patients with stage II–III colorectal cancer, and in those with the mutation, low-dose aspirin (100–162 mg daily) for three years as part of adjuvant therapy.[2]