Nordic ALASCCA study will answer the question: Can aspirin prolong survival in colorectal cancer?
Anna Martling Surgeon, chief physician, professor, dean and research group leader for the ALASCCA study. Anna Martling already has many titles. Now she can add Cancer Researcher of the Year 2021.

Anna Martling Surgeon, chief physician, professor, dean and research group leader for the ALASCCA study. Anna Martling already has many titles. Now she can add Cancer Researcher of the Year 2021.                          Ingress:

In Sweden (population 11 mill.) circa 7 000 people are diagnosed with colorectal cancer and around 2 700 die from the disease.

Colorectal cancer is the third most common cancer after prostate and breast cancer (apart from skin cancer.)

Worldwide, more than 1,4 million men and women are diagnosed with the disease, and more than 50 percent will die.

Thus, there is a high need for more efficient adjuvant therapies to improve survival in colorectal cancer.


Question: Anna Martling, how would you briefly describe the ALASCCA study?

ALASCCA is a prospective, randomized, double blinded, placebo controlled, multicenter, biomarker-based study of

adjuvant treatment with aspirin in colorectal cancer. A total of 3,800 Nordic patients will be screened.

ALASCCA is short for Adjuvant Low Dose Aspirin in Colorectal Cancer.

The primary objective of ALASCCA is to determine whether, adjuvant treatment with 160 mg aspirin once daily for 3 years, can improve time to recurrence in patients with colorectal cancer with somatic alterations in the PI3K signaling pathway. The effect of aspirin is by reducing inflammation.

However, it is not entirely certain how aspirin works in these contexts. Absolutely is inflammatory and COX-2

inhibition, in connection with the then specific mutation Pik3Ca, an important component. However, it may also be the platelet inhibitory effect of aspirin that may be significant.

Question: Why has ALASCCA taken aspirin as a starting point for such a comprehensive study?

Recent retrospective studies suggest that adjuvant treatment with common acetylsalicylic acid – such as trombyl or aspirin – after a colorectal cancer diagnosis significantly improves survival for patients with alterations in the PI3K signaling pathway. Given that alterations in the PI3K signaling pathway are found in 30 – 40 percent of all colorectal cancer this finding, if found to be proven true in a well-designed prospective study, could have tremendous improvement potential in enhancing survival in colorectal cancer.

Question: ALASCCA has been running since March 2016. Even if it is not completed, you may already be able to see what effect daily intake of low-dose aspirin has?

No, the state of knowledge is still unclear.

Observational studies have reported a decrease in colorectal cancer in regular aspirin consumers. Randomized controlled trials have shown a reduced risk of adenoma, but so far, no study specifically had the prevention of recurrence of colorectal cancer as a primary endpoint.

Now patient number 600 is randomized in ALASCCA.

As a result, we have closed the screening for new patients within the study. Now the important work of following the patients who are randomized to study drugs continues.

Our study will be evaluated regarding primary endpoint only in three years (Q2 2024) and then published.

There are 4 – 5 other aspirin studies in parallel with ours in an international perspective. However, no one is fully included and completed. We are the first to have completed inclusion and the only one to use a biomarker to control treatment.

Question: Is there a risk that individuals in the control group take low-dose aspirin and thus affect the end result?

Good question, which we also asked ourselves.

Factual information to the subjects is absolutely essential here. We do not know about ASA at all is effective for this very purpose and that it is the basis for us to do the study.

It is important that the people participating in the study understand. However, we have gradually realized that the risk is small, especially as the subjects neither do not know what the daily dose contains – aspirin or placebo nor if their tumour has the potential predictive biomarker or not. We urge all subjects to avoid aspirin and instead take paracetamol for colds, transient headaches, or the like.

Question: Should not a disease as serious as colorectal cancer be the subject of general health examinations?

The decision to recommend screening for CRC has since long been taken and planning before starting is now underway in some of the country’s 21 regions. Only Stockholm-Gotland has a fully developed screening program so far.

The National Board of Health and Welfare recommends everyone between the ages of 50 and 74 to be screened. The corona pandemic is partly due to delays.

The chance of being cured increases if the disease is detected early.

Question: What advice do at-risk patients receive regarding dietary habits?

At the group level, we know that there are certain risk factors that are linked to our lifestyle. They therefore receive partly the same advice as everyone else

others who want to live healthy; reduce intake of red meat and charcuterie, take control of body weight – avoid obesity. Coffee is good, as is a high intake of fiber.

Question: In an interview in the magazine SJUKHUSLÄKAREN 2/21, you say that “Precision medicine is the only way forward.” You mean cancer treatment.

 Can you develop it?

Precision medicine means a significantly improved ability to provide “the right treatment for the right patient at the right time”.

The ability is based on new possibilities to genetically determine each patient, to map and understand human biological variation. In the area of ​​solid tumors, such as  colorectal cancer, we are currently conducting tests for genetic changes that give us answers to the question of whether the tumor can respond to an individualized specific therapy, so-called “tailored treatment”.

In the future, we will see more and more combinations of treatments at the individual level, such as radiation + one or

several drugs. Interestingly, old drugs such as aspirin can have a renaissance when combined with new genetic and medical-technical methods.

Of course, our opportunities to achieve therapeutic success increase the more information about the patient and the more diagnostic and therapeutic methods and available drugs we have, concludes Anna Martling.      //COB

Mats Erasmie

Mats Erasmie

Chairman of the board Simplex Motion AB. Consultant in Leadership and Business Development, Erasmie&Erasmie AB.

Key Competence

Sales, Leadership as a part of a strategic changes.

  • MBA, International marketing, University of Stockholm.
  • Certified in Authentic Leadership,Transaction Analysis, Situational Leadership (SL II, Blanchard)
  • Certifed in Insight Discovery, Certifed in DISC
  • Consultant in Leadership and Business Development.
  • Erasmie&Erasmie AB.
  • Chairman of the board Simplex Motion AB.
  • Consultant at Booster Group AB, business development and negotiations.
  • Teacher at IHM, Market Analysis, Practical Marketing and Negotiations.
  • CEO, Chairman of the board and partner; Sällma AB.
  • Vice President Marketing & Sales, Consultant in Leadership and Business.
  • Development at Cordovan Performance Sweden AB.
  • CEO at Lucky Punk AB.

Books and training packages, marketing and sales, twelve in total since 1999

  • ”MED KUNDEN I FOKUS”, Liber Ekonomi 2000
  • ”KUNDRELATIONEN”, Liber Ekonomi 2001
  • ”FÖRSÄLJNING OCH SERVICE”, Liber Ekonomi 2003
  • ”PERSONLIG FÖRSÄLJNING 1”, Liber Ekonomi 2012
  • ”PERSONLIG FÖRSÄLJNING 2”, Liber Ekonomi 2014
  • ”Dödskaravanen”, Historical novel, 2018
  • ”Silverfloden”, Historical novel, 2019
  • Various articles in the magazines Ledarskap, Affärsvärlden and Dagens Industri.

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Valdet Hetemi

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Over 17 years of experience within the Pharmaceutical industry; Rx, Medical Devices, Metabolic Diseases, OTC, Logistics and Supply Chain, Business Strategy, Finance, Sales and Marketing, Start-Ups.

  • Education: Master of Business Administration and Bachelor of Social Sciences from the University of Lund and University of Cologne.
  • Head of Operations at POA Pharma Scandinavia AB, Country Manager Sweden at Vitaflo Scandinavia AB/ Navamedic AB, Finance Manager at Vitaflo Scandinavia AB/Navamedic AB.

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Martin Svahn

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Martin Svahn is a licensed pharmacist and pharmacy manager.


Licensed Pharmacist at the Universitet of Uppsala, Magisterthesis at the Departement of Anaesthesiology,,University of Uppsala. Master's Program in Clinical Pharmacy University of Uppsakla.

  • Start-up of a new privately owned pharmacy. . Worked in 2013 at K3 as GSST, Since 2014 pharmacy manager at three pharmacies with responsibility for 13-20 employees and an annual turnover of 80 million. "Cluster manager" for Kronan's pharmacy Halland.
Mats Erasmie

Andreas Larsson

Finance Manager

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Experience within the Pharmaceutical industry Rx, Medical Devices, Metabolic Diseases and OTC regarding Accounting and Finance Strategy, Financial reporting, Business Development and Logistical support

  • Master of Aeronautical Science at the University of Embry-Riddle Aeronautical University and a degree at the KY academy of finance and accounting at Studium in Gothenburg.
  • Accounting manager at POA Pharma Scandinavia AB, POA Pharma North America and Adrian & Partners AB.

Pontus Bergman

Pontus Bergman

PB Lawyer, founder of Bergman & Eek Advokat AB.

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Principal felds of practice are strategically planning for privately owned companies regarding all legal and economical matters. Special focus on developing and establishing new companies or activities abroad, including international tax law for companies and employees.

  • Education: Master of Law from University in Lund
  • Partner at Setterwalls Law Firm
  • Member of the board of POA Pharma AB and in several Swedish privately-own companies.

Tina Madsen Sandström

Tina Madsen Sandström


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Over 35 years experience within the international Pharmaceutical industry Rx, Medical Devises, OTC and   Rare Metabolic Diseases. Administration, Leadership, , Licenses & Acquisitions, Start-ups Development, Development, Management, Leadership.



Merkonom, Educated at Hillerød Business School

  • Managing Director for Pharma-Vinci A/S, Member of the branch organisation BFID
  • CEO Vitafo Scandinavia AB
  • CEO POA Pharma Scandinavia AB
  • Director of the board Vitafo Scandinavia AB
  • Director of the board POA Consulting AB
  • Director of the board POA Pharma Scandinavia AB
Roland Sandström

Roland Sandström


Key Competence

45 years experience within the international Pharmaceutical industry Rx, Medical Devices, Metabolic Diseases, OTC. Commercial Strategy, Business Development, License & Acquisitions, Start-ups Development,Management, Organisation Theory.


Master of Political Science at the University of Lund

  • Managing Director Meda Sweden
  • Board member of LSAB and LIF
  • COB Vitafo Scandinavia AB
  • Director of the board Navamedic
  • COB POA Consulting Scandinavia AB
  • COB POA Pharmas Scandinavia AB
  • COB POA Pharma North America
  • Kunden som Kompis (Customer as a Pal)
  • Articles around Project work, organisation theory and marketing
  • Lectures and abstract publications at IPMA in Paris and Ljubljana