# DYNAMIC: a blood test safely halved chemotherapy use after surgery for stage II colon cancer

Source: https://onco.cc/key-papers/paper-dynamic-nejm-2022/  
OnCo record `paper-dynamic-nejm-2022` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Giving chemotherapy only to patients with tumour DNA in their blood after surgery cut chemotherapy use from 28% to 15% with no loss in recurrence-free survival at two years.

## Summary

DYNAMIC randomised 455 patients with resected stage II colon cancer 2:1 to ctDNA-guided management or standard management. In the ctDNA arm, plasma taken at weeks 4 and 7 after surgery was tested with a tumour-informed assay; ctDNA-positive patients received oxaliplatin-based or fluoropyrimidine chemotherapy and ctDNA-negative patients were observed. The primary endpoint was recurrence-free survival at 2 years, tested for non-inferiority.

Adjuvant chemotherapy was given to 15% of ctDNA-guided patients versus 28% of standard-management patients. Two-year recurrence-free survival was 93.5% versus 92.4%, meeting non-inferiority. ctDNA-positive patients treated with chemotherapy had a 3-year RFS of 86.4%, and untreated ctDNA-negative patients 92.5%.

It was the first randomised evidence that ctDNA can safely de-escalate adjuvant treatment.

## Fields

- Kind: Key paper
- Last checked: 2026-09-08
- Journal: New England Journal of Medicine
- Year: 2022
- DOI: 10.1056/NEJMoa2200075
- Authors: Tie J, Cohen JD, Lahouel K, et al.
- Findings: Adjuvant chemotherapy use 15% vs 28% (relative risk 1.82 for standard management); Two-year recurrence-free survival 93.5% vs 92.4% (absolute difference 1.1 percentage points; 95% CI -4.1 to 6.2), non-inferior; ctDNA-positive patients treated with chemotherapy: 3-year RFS 86.4%; ctDNA-negative untreated: 92.5%; About 15% of patients were ctDNA-positive after surgery
- What it means: For stage II colon cancer, where most patients are cured by surgery alone, a blood test can identify the minority who benefit from chemotherapy and spare everyone else its side effects. It does not yet prove that treating ctDNA-positive patients improves survival compared with not treating them.
- Caveats: Non-inferiority margin of 8.5 percentage points was generous; the trial was not powered to detect small losses; Stage II only; DYNAMIC-III in stage III showed that escalation for ctDNA-positive patients did not clearly improve outcomes; Assay (Safe-SeqS on 15 tumour-specific mutations) is not the commercial assays used elsewhere; Two-year follow-up is short for colon cancer recurrence

## Sources

- DOI: https://doi.org/10.1056/NEJMoa2200075
- ANZCTR ACTRN12615000381583: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368271
- PubMed: https://pubmed.ncbi.nlm.nih.gov/35657320/
- Europe PMC full text (PMC9701133): https://europepmc.org/article/MED/35657320

## Connected records

- ideas: [ctDNA-guided adjuvant therapy as the default in stage II-III colon cancer](https://onco.cc/ideas/idea-ctdna-guided-adjuvant-crc/), [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/)
- pairings: [ctDNA MRD → adjuvant therapy decision](https://onco.cc/pairings/ctdna-mrd-to-adjuvant/)
- biomarkers: [ctDNA MRD positivity (molecular residual disease after curative treatment)](https://onco.cc/biomarkers/ctdna-mrd-positive/)
- key papers: [Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study (QUASAR)](https://onco.cc/key-papers/paper-quasar-adjuvant-chemotherapy-vs-observation-lancet-2007/), [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/), [GALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfold](https://onco.cc/key-papers/paper-galaxy-signatera-nat-med-2023/)
- cancers: [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/), [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/)
- technologies: [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- drugs: [Signatera](https://onco.cc/drugs/signatera/)
- institutions: [Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center](https://onco.cc/institutions/johns-hopkins/), [Peter MacCallum Cancer Centre](https://onco.cc/institutions/peter-mac/), [Walter and Eliza Hall Institute of Medical Research](https://onco.cc/institutions/wehi/)
- terms: [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Tumour-informed versus tumour-naive ctDNA assays](https://onco.cc/terms/tumour-informed-assay/)
- trials: [DYNAMIC](https://onco.cc/trials/dynamic/)
- people: [Bert Vogelstein](https://onco.cc/people/bert-vogelstein/), [Jeanne Tie](https://onco.cc/people/jeanne-tie/), [Kenneth W. Kinzler](https://onco.cc/people/kenneth-kinzler/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- roadmaps: [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/)

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