ctDNA/MRD Testing for Colon Cancer: A Work in Progress or Ready for Prime-Time Standard of Care?

Authors:
Bennett A. Caughey Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA

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Aparna R. Parikh Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA

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Volume/Issue:
Volume 22: Issue 10
Online Publication Date:
Dec 2024
DOI:
https://doi.org/10.6004/jnccn.2024.7049
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In patients with surgically resectable colon cancer (CC), clinicopathologic characteristics translate into cancer staging and predict recurrence risk. Adjuvant chemotherapy reduces the risk of recurrence and is offered to high-risk patients. However, some patients are inevitably overtreated or undertreated; better risk stratification is necessary to improve outcomes after surgery. Circulating tumor DNA (ctDNA)–based minimum residual disease (MRD) assays sequence plasma cell-free DNA for tumor DNA to predict the presence of otherwise subclinical malignancy. Studies have demonstrated that detectable ctDNA after surgery for CC predicts a high rate of recurrence and improves prognostication. Recent clinical trials show promise for using ctDNA to guide therapy, in particular standard-risk stage II CC. Large, randomized studies evaluating ctDNA-guided adjuvant chemotherapy versus standard of care in stage III CC are ongoing. Current data are insufficient to recommend routine use of ctDNA to guide adjuvant chemotherapy in resectable stage III CC.

Submitted December 18, 2023; final revision received May 17, 2024; accepted for publication June 17, 2024.

Disclosures: Dr. Caughey has disclosed receiving honoraria from Foundation Medicine, Inc.; and serving as an advisor/consultant for Guardant Health. Dr. Parikh has disclosed having equity in C2i Genomics, XGenomes, Cadex, and Parithera; serving as an advisor/consultant for Eli Lilly, Mirati, Pfizer, Inivata, Biofidelity, Checkmate Pharmaceuticals, Foundation Medicine, Guardant Health, AbbVie, Bayer, Delcath, Taiho, CVS, Value Analytics Labs, Seagen, Saga, AstraZeneca, Scare Inc, Illumina, Taiho, HOOKIPA and Science For America; receiving fees from UpToDate; receiving travel fees from Karkinos Healthcare; serving as a scientific advisor for Roche and Exelixis; and receiving institutional grant/research support from PureTech, PMV Pharma, Plexxikon, Takeda, Bristol Myers Squibb, Mirati, Novartis, Erasca, Genentech, Daiichi Sankyo, and Syndax.

Correspondence: Bennett A. Caughey, MD, Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, 55 Fruit Street, Boston, MA 02114. Email: bennett.caughey@gmail.com
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
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Copyright:
Copyright © 2024 by the National Comprehensive Cancer Network 2024
Article Category:
Review Article
Received:
18 Dec 2023
Accepted:
17 Jun 2024
Print Publication Date:
01 Dec 2024
Online Publication Date:
Dec 2024

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