Science translational medicine 2016-07-06
Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer.
Abstract
Detection of circulating tumor DNA (ctDNA) after resection of stage II colon cancer may identify patients at the highest risk of recurrence and help inform adjuvant treatment decisions. We used massively parallel sequencing-based assays to evaluate the ability of ctDNA to detect minimal residual disease in 1046 plasma samples from a prospective cohort of 230 patients with resected stage II colon cancer. In patients not treated with adjuvant chemotherapy, ctDNA was detected postoperatively in 14 of 178 (7.9%) patients, 11 (79%) of whom had recurred at a median follow-up of 27 months; recurrence occurred in only 16 (9.8 %) of 164 patients with negative ctDNA [hazard ratio (HR), 18; 95% confidence interval (CI), 7.9 to 40; P < 0.001]. In patients treated with chemotherapy, the presence of ctDNA after completion of chemotherapy was also associated with an inferior recurrence-free survival (HR, 11; 95% CI, 1.8 to 68; P = 0.001). ctDNA detection after stage II colon cancer resection provides direct evidence of residual disease and identifies patients at very high risk of recurrence.
Related Questions
Under what circumstances you would consider treating stage II colon cancer with adjuvant chemotherapy?
This is a very interesting question especially at present time. We know not every patient with stage II colon cancer will benefit from adjuvant chemotherapy, and the absolute survival benefit is less than 5% for 5FU based adjuvant chemo treatment (but no category 1 evidence). Oxaliplatin-based adjuv...
Are you considering the use of circulating tumor DNA or circulating tumor cell count to make clinical decisions in the adjuvant setting after colon cancer resection?
Circulating tumor DNA (ctDNA) has become commercially available with several NGS panel sequencing 70-100 genes. It is somewhat of interest in determining resistance to anti-EGFR drugs for advanced disease patients, as transient RAS mutations may emerge and then recede.In the adjuvant setting, one st...