Circulating Tumor DNA Analysis Guiding Adjuvant Therapy in Stage II Colon Cancer.
Antineoplastic Agents
/ therapeutic use
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Australia
Chemotherapy, Adjuvant
/ methods
Circulating Tumor DNA
/ analysis
Colonic Neoplasms
/ blood
Disease-Free Survival
Fluorouracil
/ therapeutic use
Humans
Neoplasm Recurrence, Local
/ prevention & control
Neoplasm Staging
Oxaliplatin
/ therapeutic use
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
16 06 2022
16 06 2022
Historique:
pubmed:
4
6
2022
medline:
18
6
2022
entrez:
3
6
2022
Statut:
ppublish
Résumé
The role of adjuvant chemotherapy in stage II colon cancer continues to be debated. The presence of circulating tumor DNA (ctDNA) after surgery predicts very poor recurrence-free survival, whereas its absence predicts a low risk of recurrence. The benefit of adjuvant chemotherapy for ctDNA-positive patients is not well understood. We conducted a trial to assess whether a ctDNA-guided approach could reduce the use of adjuvant chemotherapy without compromising recurrence risk. Patients with stage II colon cancer were randomly assigned in a 2:1 ratio to have treatment decisions guided by either ctDNA results or standard clinicopathological features. For ctDNA-guided management, a ctDNA-positive result at 4 or 7 weeks after surgery prompted oxaliplatin-based or fluoropyrimidine chemotherapy. Patients who were ctDNA-negative were not treated. The primary efficacy end point was recurrence-free survival at 2 years. A key secondary end point was adjuvant chemotherapy use. Of the 455 patients who underwent randomization, 302 were assigned to ctDNA-guided management and 153 to standard management. The median follow-up was 37 months. A lower percentage of patients in the ctDNA-guided group than in the standard-management group received adjuvant chemotherapy (15% vs. 28%; relative risk, 1.82; 95% confidence interval [CI], 1.25 to 2.65). In the evaluation of 2-year recurrence-free survival, ctDNA-guided management was noninferior to standard management (93.5% and 92.4%, respectively; absolute difference, 1.1 percentage points; 95% CI, -4.1 to 6.2 [noninferiority margin, -8.5 percentage points]). Three-year recurrence-free survival was 86.4% among ctDNA-positive patients who received adjuvant chemotherapy and 92.5% among ctDNA-negative patients who did not. A ctDNA-guided approach to the treatment of stage II colon cancer reduced adjuvant chemotherapy use without compromising recurrence-free survival. (Supported by the Australian National Health and Medical Research Council and others; DYNAMIC Australian New Zealand Clinical Trials Registry number, ACTRN12615000381583.).
Sections du résumé
BACKGROUND
The role of adjuvant chemotherapy in stage II colon cancer continues to be debated. The presence of circulating tumor DNA (ctDNA) after surgery predicts very poor recurrence-free survival, whereas its absence predicts a low risk of recurrence. The benefit of adjuvant chemotherapy for ctDNA-positive patients is not well understood.
METHODS
We conducted a trial to assess whether a ctDNA-guided approach could reduce the use of adjuvant chemotherapy without compromising recurrence risk. Patients with stage II colon cancer were randomly assigned in a 2:1 ratio to have treatment decisions guided by either ctDNA results or standard clinicopathological features. For ctDNA-guided management, a ctDNA-positive result at 4 or 7 weeks after surgery prompted oxaliplatin-based or fluoropyrimidine chemotherapy. Patients who were ctDNA-negative were not treated. The primary efficacy end point was recurrence-free survival at 2 years. A key secondary end point was adjuvant chemotherapy use.
RESULTS
Of the 455 patients who underwent randomization, 302 were assigned to ctDNA-guided management and 153 to standard management. The median follow-up was 37 months. A lower percentage of patients in the ctDNA-guided group than in the standard-management group received adjuvant chemotherapy (15% vs. 28%; relative risk, 1.82; 95% confidence interval [CI], 1.25 to 2.65). In the evaluation of 2-year recurrence-free survival, ctDNA-guided management was noninferior to standard management (93.5% and 92.4%, respectively; absolute difference, 1.1 percentage points; 95% CI, -4.1 to 6.2 [noninferiority margin, -8.5 percentage points]). Three-year recurrence-free survival was 86.4% among ctDNA-positive patients who received adjuvant chemotherapy and 92.5% among ctDNA-negative patients who did not.
CONCLUSIONS
A ctDNA-guided approach to the treatment of stage II colon cancer reduced adjuvant chemotherapy use without compromising recurrence-free survival. (Supported by the Australian National Health and Medical Research Council and others; DYNAMIC Australian New Zealand Clinical Trials Registry number, ACTRN12615000381583.).
Identifiants
pubmed: 35657320
doi: 10.1056/NEJMoa2200075
pmc: PMC9701133
mid: NIHMS1827426
doi:
Substances chimiques
Antineoplastic Agents
0
Circulating Tumor DNA
0
Oxaliplatin
04ZR38536J
Fluorouracil
U3P01618RT
Banques de données
ANZCTR
['ACTRN12615000381583']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2261-2272Subventions
Organisme : Victorian Cancer Agency
ID : Clinical Research Fellowship 14007
Organisme : NCI NIH HHS
ID : P50 CA062924
Pays : United States
Organisme : Eastern Health Foundation
ID : Linda Williams Memorial Grant
Organisme : National Health and Medical Research Council
ID : APP1085531
Organisme : Foundation for the National Institutes of Health
ID : P50-CA062924, CA06973, CA176828, and CA210170
Organisme : National Health and Medical Research Council
ID : APP1194970
Investigateurs
Madhu Singh
(M)
Sam Harris
(S)
Craig Underhill
(C)
Jeremy Shapiro
(J)
Fiona Day
(F)
Desmond Yip
(D)
Lisa Horvath
(L)
Rachel Wong
(R)
Margaret Lee
(M)
Sumitra Ananda
(S)
Adnan Khattak
(A)
Christos Karapetis
(C)
Peter Gibbs
(P)
Marion Harris
(M)
Jenny Shannon
(J)
James Lynam
(J)
Belinda Lee
(B)
Jeanne Tie
(J)
Matthew Burge
(M)
Louise Nott
(L)
Theresa Hayes
(T)
Sue-Anne McLachlan
(SA)
Susanne Kosmider
(S)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2022 Massachusetts Medical Society.
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