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Background  Use of aspirin after diagnosis of colon cancer has been associated with improved survival. Identification of cancer subtypes that respond to aspirin treatment may help develop personalized treatment regimens. The aim of this study was to investigate the influence of  BRAF  and  KRAS  mutation status on the association between aspirin use and overall survival after colon cancer diagnosis.    Methods  A random selection of 599 patients with colon cancer were analyzed, selected from the Eindhoven Cancer Registry, and  BRAF  and  KRAS  mutation status was determined. Data on aspirin use (80 mg) were obtained from the PHARMO Database Network. Parametric survival models with exponential (Poisson) distribution were used.    Results  Aspirin use after colon cancer diagnosis was associated with improved overall survival in wild-type  BRAF  tumors, adjusted rate ratio (RR) of 0.60 (95% CI 0.44–0.83). In contrast, aspirin use in  BRAF  mutated tumors was not associated with an improved survival (RR 1.11, 95% CI 0.57–2.16).  P-value  for interaction was non-significant.  KRAS  mutational status did not differentiate in the association between aspirin use and survival.    Conclusion  Low-dose aspirin use after colon cancer diagnosis was associated with improved survival in  BRAF  wild-type tumors only. However, the large confidence interval of the rate ratio for the use of aspirin in patients with  BRAF  mutation does not rule out a possible benefit. These results preclude  BRAF  and  KRAS  mutation status to be used as a marker for individualized treatment with aspirin, if aspirin becomes regular adjuvant treatment for colon cancer patients in the future.

The Influence of BRAF and KRAS Mutation Status on the Association between Aspirin Use and Survival after Colon Cancer Diagnosis