ASCO: ctDNA Analysis Guides Treatment of Stage II Colon Cancer

ctDNA-guided approach to determining the need for adjuvant therapy noninferior to standard management for recurrence-free survival

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MONDAY, June 6, 2022 (HealthDay News) -- A circulating tumor DNA (ctDNA)-guided approach to treatment of stage II colon cancer reduces adjuvant chemotherapy use without affecting recurrence-free survival, according to a study published online June 4 in the New England Journal of Medicine to coincide with the annual meeting of the American Society of Clinical Oncology, held from June 3 to 7 in Chicago.

Jeanne Tie, M.D., from the Walter and Eliza Hall Institute of Medical Research in Parkville, Australia, and colleagues examined whether a ctDNA-guided approach could reduce the use of adjuvant chemotherapy without compromising recurrence risk among patients with stage II colon cancer. Participants were randomly assigned to have treatment decisions guided by ctDNA results or standard clinicopathological features. A ctDNA-positive result at four or seven weeks after surgery prompted oxaliplatin-based or fluoropyrimidine chemotherapy in the ctDNA-guided management approach. A total of 455 patients were randomly assigned: 302 to ctDNA-guided management and 153 to standard management.

The researchers found that compared with the standard-management group, a lower percentage of patients in the ctDNA-guided group received adjuvant chemotherapy (15 versus 28 percent). ctDNA-guided management was noninferior to standard management in the evaluation of two-year recurrence-free survival (93.5 and 92.4 percent, respectively). Three-year recurrence-free survival was 86.4 and 92.5 percent for ctDNA-positive patients who received adjuvant chemotherapy and among ctDNA-negative patients who did not, respectively.

"We found that a ctDNA-guided approach reduced the number of patients who received adjuvant therapy and did not alter the risk of recurrence," the authors write. "Furthermore, ctDNA-positive patients appeared to derive considerable benefit from adjuvant treatment."

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