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Gastrointestinal cancer

Early MRD predicts disease recurrence and benefit from adjuvant chemotherapy in CRC

Nature Reviews Clinical Oncology volume 20, page 137 (2023)Cite this article

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More than 30% of patients with resectable colorectal cancer (CRC) have disease recurrence after surgery, and adjuvant chemotherapy (ACT) is therefore recommended for those with stage III disease or with stage II disease and high-risk clinicopathological features. However, this approach to patient selection is suboptimal, resulting in overtreatment of many and undertreatment of some. Now, new data from the observational GALAXY cohort of the ongoing CIRCULATE-Japan study support the potential of minimal residual disease (MRD) to guide decision-making in this setting.

Plasma ctDNA levels prior to surgery tended to increase with pathological stage, and higher baseline ctDNA levels were associated with a greater likelihood of MRD positivity at 4 weeks after surgery. Moreover, MRD status at 4 weeks was highly prognostic: 18-month disease-free survival (DFS) was 38.4% in 187 patients who were MRD-positive versus 90.5% in 852 patients who were MRD-negative (HR 10.0, 95% CI 7.7–14.0; P < 0.0001). Notably, MRD positivity at 4 weeks was associated with a greater increase in recurrence risk for earlier disease stages (HR 37.0, 18.0, 9.6 and 5.9 for stages I, II, III and IV, respectively), a finding that might have important implications for patient selection, particularly for identifying the subset of patients with stage I or low-risk stage II CRC who are undertreated according to the current guidelines for ACT.

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  1. Nature Reviews Clinical Oncology http://www.nature.com/nrclinonc

    David Killock

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  1. David Killock
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Correspondence to David Killock.

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Killock, D. Early MRD predicts disease recurrence and benefit from adjuvant chemotherapy in CRC. Nat Rev Clin Oncol 20, 137 (2023). https://doi.org/10.1038/s41571-023-00737-2

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