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Circulating Tumor DNA: Towards More Individualized Treatment for Patients with Resectable Colorectal Cancer

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Abstract

Purpose

Despite curative-intent treatment, recurrence is common for patients with colorectal cancer (CRC).  Currently, prediction of disease recurrence and prognostication following surgery is based upon vague clinical factors and more precise and dynamic biomarkers for risk stratification and treatment decisions are urgently needed.  Circulating tumor DNA (ctDNA) is a promising biomarker for patients undergoing treatment for resectable CRC.

Methods

In this review, we provide an overview of the data supporting current uses of ctDNA for CRC, including localized CRC and resectable colorectal liver metastases (CLM), as well as descriptions of important ongoing clinical trials using ctDNA in the care of patients with CRC.

Results

The detection of ctDNA following curative-intent therapy is associated with disease recurrence, and multiple trials are investigating its role in determining need and duration for adjuvant therapy for localized CRC. In addition, ctDNA reliably predicts prognosis for patients with CLM, with trials underway studying ctDNA-guided treatment sequencing and intensity.

Conclusion

The detection of ctDNA is a sensitive and dynamic biomarker for disease recurrence in CRC. Many investigations are underway into ctDNA’s potential role in surveillance and treatment algorithms, and it has the potential to become a critical biomarker to determine individualized strategies for treatment sequencing, choice, and duration of therapies.

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Authors and Affiliations

  1. Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA

    Alexandra M. Adams

  2. Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA

    Timothy J. Vreeland

  3. Department of Surgical Oncology, Brooke Army Medical Center, San Antonio, TX, USA

    Timothy J. Vreeland

  4. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Timothy E. Newhook

Authors
  1. Alexandra M. Adams
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  2. Timothy J. Vreeland
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  3. Timothy E. Newhook
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Contributions

TEN was responsible for the initial conception and outline of the manuscript, and for Figs. 1 and 2. AMA created Table 1. All authors contributed significantly to each draft of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Timothy E. Newhook.

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The authors declare no competing interests.

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Adams, A.M., Vreeland, T.J. & Newhook, T.E. Circulating Tumor DNA: Towards More Individualized Treatment for Patients with Resectable Colorectal Cancer. J Gastrointest Canc 54, 1071–1081 (2023). https://doi.org/10.1007/s12029-022-00888-y

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