Karolinska University Hospital first in the world to introduce expanded testing for colorectal cancer

Karolinska University Hospital is the first hospital in the world to implement broad molecular reflex testing for colorectal cancer, based on the Nordic ALASCCA study. The study shows that low-dose aspirin can halve the risk of recurrence in patients with specific genetic alterations in their tumors.

The hospital is now introducing a comprehensive DNA panel for molecular reflex testing of colorectal cancer. The decision is based on the results of the Nordic ALASCCA study, recently published in The New England Journal of Medicine. The study, led by Professor Anna Martling at Karolinska Institutet and senior consultant at Karolinska University Hospital, demonstrated that a low dose of aspirin can halve the risk of recurrence after surgery in patients whose tumors carry certain genetic changes.

“This is a major step forward for precision medicine in colorectal cancer. Thanks to research, we can now offer patients more targeted treatment and identify those who benefit from additional therapy with aspirin,” says Annika Sjövall, Associate Professor at Karolinska Institutet and senior consultant in colorectal cancer surgery at Karolinska University Hospital.

Each year, nearly two million people worldwide are diagnosed with colorectal cancer. Between 20 and 40 percent develop metastases, making the disease more difficult to treat and more deadly.

In the ALASCCA study, which included more than 3,500 patients from 33 hospitals in Sweden, Norway, Denmark, and Finland, researchers showed that three years of adjuvant treatment with aspirin after surgery reduced the risk of recurrence by about 50 percent in patients whose tumors carried mutations in the PI3K signaling pathway.

“Aspirin is being tested here in an entirely new context as a precision medicine treatment. It is a clear example of how we can use genetic information to individualize therapy while saving both resources and patient suffering,” says Johan Lindberg, bioinformatician at Karolinska University Hospital, Associate Professor at Karolinska Institutet, and senior author of the ALASCCA study.

Karolinska University Hospital’s Department of Clinical Pathology and Cancer Diagnostics already performs molecular reflex testing on all diagnostic biopsies where colorectal cancer is found. The difference now is that the narrow, commercial panel will be replaced by the broad panel used in the ALASCCA study – the so-called GMCK panel, developed by Johan Lindberg’s group at Karolinska Institutet and already established in clinical practice for ovarian and endometrial cancers.

The new panel:

• covers all relevant genes in the PI3K signaling pathway – it is carriers of PI3K mutations who should be treated with aspirin,
• provides results on complex markers such as microsatellite instability and tumor mutational burden,
• can detect hereditary cancer genes causing, for example, Lynch syndrome,
• identifies mutations that affect how patients metabolize certain chemotherapies.

“The implementation demonstrates the value of close integration between research and clinical care. It allows us to rapidly translate research findings into practical benefit for patients,” says Johan Lindberg.

Karolinska University Hospital is the first in the world to introduce this type of reflex testing in routine clinical practice. The development will have implications for the entire country, and other hospitals in Sweden are expected to implement similar testing in the future. The hospital is also open to receiving samples from external providers that do not yet offer the new panel.

Currently, testing includes all biopsies diagnosed at Karolinska University Hospital’s pathology laboratories in Solna, Huddinge, Danderyd, and Södersjukhuset.

Karolinska University Hospital

Press Officer 

+46 8 517 740 10

presstjanst.karolinska@regionstockholm.se

Karolinska is one of Europe's largest university hospitals and together with Karolinska Institutet we have a leading role within the field of medical breakthroughs. Our aim is to always put the patient first by providing the best possible medical expertise, treatment and care. Through innovation and active collaboration with industry and academia, we are committed to being internationally prominent in medicine, research and education.