This summer’s ESMO Gastrointestinal Cancers Congress spotlighted groundbreaking research on ctDNA, reinforcing utility in colorectal cancer care.  Across multiple studies, ctDNA emerged as a powerful tool for surveillance, treatment guidance, and recurrence prediction.

  • GALAXY & BESPOKE-CRC: ctDNA status during routine follow-up can better identify CRC patients who are candidates for metastasis-directed therapy (MDT).  ctDNA positive patients had up to 20 times higher likelihood of receiving MDT compared to ctDNA negative patients.
  • ALTAIR Trial: Lonsurf has the potential to treat MRD in CRC patients. Even though statistical significance was not reached, ctDNA clearance was higher in patients who received Lonsurf compared to patients who received placebo.  In addition, no new safety signals emerged and there was no lasting deterioration in quality of life after treatment.
  • PRODIGE54: Changes in ctDNA predicted long-term outcomes in microsatellite high metastatic CRC patients. A decrease in ctDNA within one month significantly correlated with both progression free and overall survival.  This correlation was stronger in patients treated with immunotherapy compared to patients treated with chemotherapy.
  • Prospective Italian Multicenter Study: ctDNA dynamics correlated with recurrence-free survival in resected liver-limited metastatic CRC patients after first-line systemic therapy. Patients who were ctDNA negative after resection experienced longer median recurrence-free survival than patients who were ctDNA positive.
  • Largest Liquid Biopsy Cohort: Liquid biopsy has an ability to detect treatment-relevant mutations in most non-resectable metastatic CRC tumors. This is especially true for patients with liver metastases in that it accurately identified key mutations like KRAS and BRAF.  However, it is less effective in patients with metastases limited to the lung and peritoneum.
  • Ten Study Meta-Analysis: ctDNA has a prognostic impact on recurrence-free survival in that ctDNA positivity is strongly associated with poor recurrence free survival in CRC patients.
  • Retrospective Real-World Analysis: A tissue-free ctDNA assay can detect MRD and predict recurrence in CRC patients.  ctDNA negative results were highly predictive of disease-free survival, particularly in stage II patients.  However, higher recurrence rates in ctDNA negative stage III patients emphasize the need for continued monitoring.
  • Analytical Validation: Adding quantitation to the tumor-informed ctDNA assay provides additional prognostic information which may help inform clinical decision making. In stage III CRC ctDNA positive patients, higher quantitative values (MTM/mL) were associated with a higher likelihood of recurrence during surveillance.