The promise of circulating tumor DNA (ctDNA) in the management of early-stage colon cancer: A critical review

Sakti Chakrabarti, Hao Xie, Raul Urrutia, Amit Mahipal

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

The current standard treatment for patients with early-stage colon cancer consists of surgical resection, followed by adjuvant therapy in a select group of patients deemed at risk of cancer recurrence. The decision to administer adjuvant therapy, intended to eradicate the clinically inapparent minimal residual disease (MRD) to achieve a cure, is guided by clinicopathologic characteristics of the tumor. However, the risk stratification based on clinicopathologic characteristics is imprecise and results in under or overtreatment in a substantial number of patients. Emerging research indicates that the circulating tumor DNA (ctDNA), a fraction of cell-free DNA (cfDNA) in the bloodstream that originates from the neoplastic cells and carry tumor-specific genomic alterations, is a promising surrogate marker of MRD. Several recent studies suggest that ctDNA-guided risk stratification for adjuvant therapy outperforms existing clinicopathologic prognostic indicators. Preliminary data also indicate that, aside from being a prognostic indicator, ctDNA can inform on the efficacy of adjuvant therapy, which is the underlying scientific rationale for several ongoing clinical trials evaluating ctDNA-guided therapy escalation or de-escalation. Furthermore, serial monitoring of ctDNA after completion of definitive therapy can potentially detect cancer recurrence much earlier than conventional surveillance methods that may provide a critical window of opportunity for additional curative-intent therapeutic interventions. This article presents a critical overview of published studies that evaluated the clinical utility of ctDNA in the management of patients with early-stage colon cancer, and the potential of ctDNA to transform the adjuvant therapy strategies.

Original languageEnglish (US)
Article number2808
Pages (from-to)1-18
Number of pages18
JournalCancers
Volume12
Issue number10
DOIs
StatePublished - Oct 2020

Keywords

  • Adjuvant therapy
  • Circulating tumor DNA (ctDNA)
  • Colon cancer
  • Early-stage colon cancer
  • Minimal residual disease (MRD)
  • Next-generation sequencing

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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