# DYNAMIC

Source: https://onco.cc/trials/dynamic/  
OnCo record `dynamic` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Showed that a blood test can safely halve the number of colon cancer patients given chemotherapy after surgery.

## Summary

DYNAMIC, registered as ACTRN12615000381583, sponsored by the Walter and Eliza Hall Institute and published in the New England Journal of Medicine in 2022, showed that a circulating tumour DNA blood test can safely halve the number of stage II colon cancer patients given chemotherapy after surgery. It randomised 455 patients to ctDNA-guided management or standard management, and chemotherapy use fell from 28 to 15 percent while two-year recurrence-free survival was non-inferior. DYNAMIC-III in stage III gave a more nuanced result, and whether escalating treatment in ctDNA-positive patients helps is the open question.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-04
- Registry id: ACTRN12615000381583
- Phase: 2
- Setting: Stage II colon cancer: ctDNA-guided adjuvant chemotherapy vs standard management
- Sponsor: Walter and Eliza Hall Institute
- Enrolled: 455
- Result: Chemotherapy use 15% vs 28% with non-inferior RFS.
- Outcomes: Recurrence-free survival at 2 years (non-inferiority): ctDNA-guided management 93.5% vs Standard management 92.4%; Patients receiving adjuvant chemotherapy: ctDNA-guided management 15% vs Standard management 28%
- Replication: Supported by observational cohorts (CIRCULATE-Japan GALAXY); DYNAMIC-III in stage III gave a more nuanced result, and randomised escalation trials are ongoing.

## Sources

- NEJM 2022: https://www.nejm.org/doi/full/10.1056/NEJMoa2200075

## Connected records

- cancers: [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/), [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- technologies: [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- terms: [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Colectomy](https://onco.cc/terms/colectomy/), [De-escalation, escalation and response-adapted therapy](https://onco.cc/terms/de-escalation/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Non-inferiority margin and equivalence trials](https://onco.cc/terms/non-inferiority-margin/), [Non-inferiority trial](https://onco.cc/terms/non-inferiority/), [SMART design (sequential multiple assignment randomised trial)](https://onco.cc/terms/smart-design/), [Trial registration and results reporting (ClinicalTrials.gov, EU CTR)](https://onco.cc/terms/trial-registration/), [Tumour-informed versus tumour-naive ctDNA assays](https://onco.cc/terms/tumour-informed-assay/)
- trials: [ALTAIR](https://onco.cc/trials/altair/), [CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)](https://onco.cc/trials/circulate-japan/), [CIRCULATE-US](https://onco.cc/trials/circulate-us/), [DYNAMIC-III](https://onco.cc/trials/dynamic-iii/), [QUASAR](https://onco.cc/trials/quasar/), [TRACC](https://onco.cc/trials/tracc/)
- people: [Jeanne Tie](https://onco.cc/people/jeanne-tie/)
- key papers: [Analysis of plasma cell-free DNA by ultradeep sequencing in patients with stages I to III colorectal cancer](https://onco.cc/key-papers/paper-reinert-ctdna-ultradeep-sequencing-colorectal-jama-oncol-2019/), [Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer](https://onco.cc/key-papers/paper-tie-ctdna-minimal-residual-disease-stage-ii-colon-sci-transl-med-2016/), [Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer: 5-year outcomes of the randomized DYNAMIC trial](https://onco.cc/key-papers/paper-dynamic-nat-med-2025-update/), [DYNAMIC: a blood test safely halved chemotherapy use after surgery for stage II colon cancer](https://onco.cc/key-papers/paper-dynamic-nejm-2022/)
- ideas: [A national platform trial that every ctDNA-positive patient can join](https://onco.cc/ideas/idea-bio2-national-mrd-platform/), [A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled](https://onco.cc/ideas/idea-moon-mrd-weather-service/), [ctDNA-guided adjuvant therapy as the default in stage II-III colon cancer](https://onco.cc/ideas/idea-ctdna-guided-adjuvant-crc/), [Formally qualify tumour-DNA blood tests as a surrogate endpoint for adjuvant trials](https://onco.cc/ideas/idea-tr2-ctdna-mrd-qualification/), [Strip the platelet coat off travelling tumour cells in ctDNA-positive patients](https://onco.cc/ideas/idea-bio2-platelet-cloak-aspirin-mrd/), [Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps](https://onco.cc/ideas/idea-crc-ctdna-de-escalation-beyond-stage-ii/), [Use tumour DNA in blood to decide when to pause treatment in metastatic cancer](https://onco.cc/ideas/idea-tr1-ctdna-guided-stop-in-metastatic-disease/)
- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/), [ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment](https://onco.cc/roadmaps/ctdna-tests/), [Diagnostics roadmap: stains → gene panels → blood tests that decide treatment](https://onco.cc/roadmaps/diagnostics-roadmap/), [Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on](https://onco.cc/roadmaps/trial-modernisation-roadmap/)
- pairings: [ctDNA MRD → adjuvant therapy decision](https://onco.cc/pairings/ctdna-mrd-to-adjuvant/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [Metastasis is understood least and studied last](https://onco.cc/bottlenecks/b-metastasis-biology/)
- pathways: [Clonal evolution & minimal residual disease](https://onco.cc/pathways/clonal-evolution/)
- companies: [Australasian Gastro-Intestinal Trials Group](https://onco.cc/companies/agitg/)

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JSON: https://onco.cc/api/v1/entities/dynamic.json