Circulating Tumor DNA-Guided Adjuvant and Post-Adjuvant Therapy in Resected Colorectal Cancer: From Molecular Residual Disease Detection to Proven Clinical Utility
- Study type
- Review article
- Design
- Critical review of evidence from clinical trials and observational studies
- Sample size
- Not applicable (review article)
- Source
- Biomedicines · 2026
In plain words
After surgery for bowel (colorectal) cancer, tiny traces of the tumour sometimes remain that cannot be seen with the usual methods, but they can be detected with a blood test that tracks tumour DNA (ctDNA). The evidence shows this test can help identify patients who probably do not need chemotherapy, without raising the risk of the cancer coming back. But in patients whose test is positive, more intensive chemotherapy has so far not improved the outcome. Any decision about using this test should be made with your treating doctor.
Key results
Study population
Patients with colorectal cancer who have undergone curative-intent surgery (resection); the main focus is stage 2 and 3 disease.
Endpoints
This paper is a review and has no specific endpoint. The endpoints reported from the studies reviewed in the abstract include recurrence-free survival, disease-free survival and the rate of adjuvant chemotherapy use.
Safety and side effects
No data on adverse events are reported in the abstract. Safety information should be checked in the full text of the paper and the primary trial reports.
Clinical significance and place in guidelines
Based on the abstract, ctDNA is the strongest prognostic marker in resected colorectal cancer, and in stage 2 colon cancer it can reduce the use of adjuvant chemotherapy without loss of recurrence-free survival (the DYNAMIC trial). In contrast, escalating chemotherapy in ctDNA-positive stage 3 patients (DYNAMIC-III) and treatment with trifluridine/tipiracil at molecular relapse (ALTAIR) showed no significant benefit. The evidence therefore currently supports a de-escalation strategy more than escalation. The status of this test in clinical guidelines and regulatory approvals should be checked separately, as the abstract does not address it.
Limitations
This paper is a review and presents no new primary data. According to the authors, future progress requires biomarker-matched escalation strategies, adaptive trial designs and formal validation of ctDNA clearance as a surrogate endpoint. The confidence interval reported for the DYNAMIC trial is given here exactly as printed in the abstract and should be checked against the full text or the primary source.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.