ctDNA-guided adjuvant therapy as the default in stage II-III colon cancer
Use a blood test after surgery to decide who gets chemotherapy: spare the negatives, and find something that actually works for the positives.
DYNAMIC showed ctDNA-negative stage II patients can safely skip chemotherapy. ALTAIR showed that treating ctDNA-positive patients with late-line trifluridine/tipiracil does not help; escalation needs better agents (oxaliplatin-based, immunotherapy for dMMR, or targeted therapy by clone).
The blood test stratifies risk far better than stage or pathology. It supports treating ctDNA-positive patients and suggests ctDNA-negative patients gain little from chemotherapy, but because treatment was not randomised the de-escalation claim needs the randomised trials that are now under way.
For stage II colon cancer, where most patients are cured by surgery alone, a blood test can identify the minority who benefit from chemotherapy and spare everyone else its side effects. It does not yet prove that treating ctDNA-positive patients improves survival compared with not treating them.
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not linked directly; found by shared links- PairingctDNA MRD → adjuvant therapy decision
Shares Formally qualify tumour-DNA blood tests as a surrogate endpoint for adjuvant trials, DYNAMIC: a blood test safely halved chemotherapy use after surgery for stage II colon cancer, DYNAMIC, Signatera.
- IdeaStrip the platelet coat off travelling tumour cells in ctDNA-positive patients
Shares DYNAMIC, CIRCULATE-Japan (GALAXY / VEGA / ALTAIR), Metastasis is understood least and studied last, Dormant cells and minimal residual disease.
- IdeaA national residual-disease weather service: serial blood tests for every curatively treated patient, pooled
Shares DYNAMIC, Signatera, Dormant cells and minimal residual disease, Minimal / molecular residual disease (MRD).
- IdeaA national platform trial that every ctDNA-positive patient can join
Shares DYNAMIC, CIRCULATE-Japan (GALAXY / VEGA / ALTAIR), Dormant cells and minimal residual disease, Minimal / molecular residual disease (MRD).
- IdeaBlunt the inflammation that wakes sleeping cancer cells
Shares Metastasis is understood least and studied last, Dormant cells and minimal residual disease, Minimal / molecular residual disease (MRD), MRD / molecular residual disease testing.
- IdeaFlush dormant cells out of bone marrow, then kill them
Shares Metastasis is understood least and studied last, Dormant cells and minimal residual disease, Minimal / molecular residual disease (MRD), MRD / molecular residual disease testing.
- IdeaIntercepting late recurrence with ctDNA surveillance and oral SERDs
Shares Signatera, Dormant cells and minimal residual disease, Minimal / molecular residual disease (MRD), MRD / molecular residual disease testing.
- IdeaMetastasis prevention as a formal indication with its own trials and regulatory pathway
Shares Metastasis is understood least and studied last, Minimal / molecular residual disease (MRD), MRD / molecular residual disease testing, Colorectal cancer.