DYNAMIC

Regimen

Experimental
ctDNA-guided adjuvant: chemotherapy if ctDNA-positive at 4 or 7 weeks post-op; observation if ctDNA-negative
Control
Standard clinicopathological-based adjuvant chemotherapy decision

Population

Stage II colon cancer after curative resection, ctDNA-guided vs standard adjuvant decision (N=455).

Key finding

ctDNA-guided management noninferior to standard management for 2-year RFS (93.5% vs 92.4%, absolute difference +1.1%). Adjuvant chemotherapy use reduced from 28% to 15% (RR 1.82). ctDNA-positive patients who received chemotherapy had 3-year RFS 86.4% vs 92.5% for ctDNA-negative patients who did not receive chemotherapy. First RCT validating ctDNA-guided adjuvant decision-making.

Source: PMID 35657320

Timeline

    Guideline citations

    • NCCN Colon (p.98)
    • NCCN Rectal (p.34)