Molecular residual disease and efficacy of adjuvant chemotherapy in patients with colorectal cancer
Menée au Japon à partir de données portant sur 1 039 patients atteints d'un cancer colorectal résécable de stade II à IV (durée médiane de suivi : 16,74 mois) et menée à partir d'échantillons tumoraux fixés au formaldéhyde et inclus en paraffine, cette étude évalue l'intérêt de détecter l'ADN tumoral circulant après le traitement chirurgical pour identifier les patients présentant un risque élevé de récidive et pour lesquels une chimiothérapie adjuvante peut s'avérer efficace
Despite standard-of-care treatment, more than 30% of patients with resectable colorectal cancer (CRC) relapse. Circulating tumor DNA (ctDNA) analysis may enable postsurgical risk stratification and adjuvant chemotherapy (ACT) treatment decision-making. We report results from GALAXY, which is an observational arm of the ongoing CIRCULATE-Japan study (UMIN000039205) that analyzed presurgical and postsurgical ctDNA in patients with stage II–IV resectable CRC (n = 1,039). In this cohort, with a median follow-up of 16.74 months (range 0.49–24.83 months), postsurgical ctDNA positivity (at 4 weeks after surgery) was associated with higher recurrence risk (hazard ratio (HR) 10.0, P < 0.0001) and was the most significant prognostic factor associated with recurrence risk in patients with stage II or III CRC (HR 10.82, P < 0.001). Furthermore, postsurgical ctDNA positivity identified patients with stage II or III CRC who derived benefit from ACT (HR 6.59, P < 0.0001). The results of our study, a large and comprehensive prospective analysis of ctDNA in resectable CRC, support the use of ctDNA testing to identify patients who are at increased risk of recurrence and are likely to benefit from ACT.
Nature Medicine , article en libre accès, 2023