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ctDNA-guided adjuvant therapy in stage II colon cancer

One-paragraph summary

DYNAMIC randomized 455 resected stage II colon patients to ctDNA-guided or standard clinicopathologic management. Chemotherapy use fell from 28% to 15%; 2-year recurrence-free survival was 93.5% versus 92.4%, meeting the prespecified noninferiority margin. ctDNA-positive patients received oxaliplatin-based or fluoropyrimidine therapy; negative patients generally did not (PMID 35657320).

Key findings

  • A biomarker strategy reduced chemotherapy by 13 percentage points.
  • Two-year recurrence-free survival was not compromised within the trial margin.
  • Postoperative positivity identified a high-risk minority.
  • The trial evaluated an action algorithm, not prognostic association alone.

Limitations

  • One assay/timing algorithm; not a class effect for all ctDNA tests.
  • ctDNA-negative recurrence still occurred.
  • Escalation efficacy in positive patients was not isolated.
  • Stage III and rectal generalization requires separate trials.

Why it matters

DYNAMIC is the first major randomized proof that postoperative ctDNA can change adjuvant treatment while preserving an outcome—not merely predict recurrence.

Cited by wiki pages

  • Overview
  • Localized colon cancer
  • Biomarkers and liquid biopsy
  • Clinical trials landscape
  • Guidelines