| Rank |
Pathway / Axis |
Cancer Cells |
Normal Cells |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
Platelet COX-1 → TXA₂ |
Indirect: platelet shielding of CTCs ↓; platelet-assisted extravasation/metastatic seeding ↓ (context-dependent) |
Platelet aggregation ↓; hemostasis capacity ↓ (bleeding risk ↑) |
P |
Antiplatelet state via irreversible COX-1 acetylation |
High mechanistic centrality at low dose because platelets cannot resynthesize COX-1; effects persist beyond plasma aspirin exposure. |
| 2 |
COX-2 → PGE₂ inflammatory tumor microenvironment |
Inflammatory prostanoid signaling ↓; pro-tumor inflammation ↓ (dose/context dependent) |
GI mucosal protection ↓ (ulcer/bleeding risk ↑); renal prostaglandin effects (risk in susceptible patients) |
R |
Anti-inflammatory prostanoid suppression |
COX-2 modulation is less selectively targeted than platelet COX-1 at “low-dose”; relevance increases with higher systemic exposure. |
| 3 |
Platelet TXA₂ → T-cell suppression axis |
Anti-metastatic immunity ↑ (T-cell effector function ↑; metastasis permissiveness ↓) |
Immune modulation ↔ (context-dependent) |
R |
Release of T-cell suppression linked to platelet TXA₂ |
Mechanistic bridge between antiplatelet action and metastasis control; aligns with platelet-first hypothesis for low-dose aspirin. |
| 4 |
PI3K-pathway–altered CRC recurrence signal |
Recurrence risk ↓ in PI3K-altered localized CRC (biomarker-stratified benefit) |
Systemic bleeding risk ↑ remains |
G |
Genotype-linked clinical leverage (adjuvant context) |
Represents actionable stratification logic: benefit concentrated in molecular subsets rather than pan-CRC. |
| 5 |
Immune checkpoint coupling: PD-L1 |
PD-L1 ↓ (model-dependent) → immune evasion ↓ (context-dependent) |
Immune effects ↔ |
G |
Potential immunomodulatory adjunct axis |
Reported in specific tumor models via transcription/epigenetic regulators; translation likely tumor-type and context dependent. |
| 6 |
Apoptosis balance |
Apoptosis ↑; BAX ↑; Bcl-2 ↓ (model-dependent) |
Cell stress/irritation ↔ (context-dependent) |
G |
Secondary pro-death signaling in some models |
Often requires higher concentrations than antiplatelet dosing; treat as supportive rather than primary for real-world low-dose exposure. |
| 7 |
Clinical Translation Constraint |
Benefit heterogeneity ↑ (tumor subtype, age, bleeding risk, concomitant therapy) |
GI bleeding ↑; hemorrhagic stroke risk ↑ (baseline-dependent); hypersensitivity in susceptible patients |
G |
Therapeutic window constrained by bleeding and population selection |
Major limiter for preventive use in older adults; drug–drug interactions (anticoagulants/other NSAIDs) and peri-procedural management are practical constraints. |