{"entity":{"id":"dynamic","kind":"trial","name":"DYNAMIC","aka":[],"tldr":"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.","status":"positive","asOf":"2026-09-04","links":[{"label":"NEJM 2022","url":"https://www.nejm.org/doi/full/10.1056/NEJMoa2200075"}],"tags":[],"related":[],"cancers":["colorectal"],"sections":[],"technologies":["mrd-testing"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["mrd","ctdna","de-escalation"],"trials":["dynamic-iii","altair","circulate-us","quasar"],"people":["jeanne-tie"],"bottlenecks":[],"keyPapers":["paper-tie-ctdna-minimal-residual-disease-stage-ii-colon-sci-transl-med-2016","paper-reinert-ctdna-ultradeep-sequencing-colorectal-jama-oncol-2019","paper-dynamic-nejm-2022","paper-dynamic-nat-med-2025-update"],"journals":[],"dependsOn":[],"notes":[],"nct":"ACTRN12615000381583","phase":"2","setting":"Stage II colon cancer: ctDNA-guided adjuvant chemotherapy vs standard management","sponsor":"Walter and Eliza Hall Institute","result":"Chemotherapy use 15% vs 28% with non-inferior RFS.","yearReported":2022,"enrolled":455,"enrolledBasis":"registry","outcomes":[{"endpoint":"Recurrence-free survival at 2 years (non-inferiority)","primary":true,"unit":"%","arms":[{"name":"ctDNA-guided management","n":302,"value":93.5,"note":"Non-inferiority met (margin −8.5 points)"},{"name":"Standard management","n":153,"value":92.4}],"source":"https://www.nejm.org/doi/full/10.1056/NEJMoa2200075"},{"endpoint":"Patients receiving adjuvant chemotherapy","unit":"%","arms":[{"name":"ctDNA-guided management","value":15},{"name":"Standard management","value":28}],"p":"<0.001","source":"https://www.nejm.org/doi/full/10.1056/NEJMoa2200075"}],"replication":"Supported by observational cohorts (CIRCULATE-Japan GALAXY); DYNAMIC-III in stage III gave a more nuanced result, and randomised escalation trials are ongoing."},"route":"/trials/dynamic/","neighbours":{"cancer":[{"id":"colon-cancer","kind":"cancer","name":"Colon cancer (adenocarcinoma of the colon)","route":"/cancers/colon-cancer/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"technology":[{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"term":[{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"colectomy","kind":"term","name":"Colectomy","route":"/terms/colectomy/"},{"id":"de-escalation","kind":"term","name":"De-escalation, escalation and response-adapted therapy","route":"/terms/de-escalation/"},{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"},{"id":"non-inferiority-margin","kind":"term","name":"Non-inferiority margin and equivalence trials","route":"/terms/non-inferiority-margin/"},{"id":"non-inferiority","kind":"term","name":"Non-inferiority trial","route":"/terms/non-inferiority/"},{"id":"smart-design","kind":"term","name":"SMART design (sequential multiple assignment randomised trial)","route":"/terms/smart-design/"},{"id":"trial-registration","kind":"term","name":"Trial registration and results reporting (ClinicalTrials.gov, EU CTR)","route":"/terms/trial-registration/"},{"id":"tumour-informed-assay","kind":"term","name":"Tumour-informed versus tumour-naive ctDNA assays","route":"/terms/tumour-informed-assay/"}],"trial":[{"id":"altair","kind":"trial","name":"ALTAIR","route":"/trials/altair/"},{"id":"circulate-japan","kind":"trial","name":"CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)","route":"/trials/circulate-japan/"},{"id":"circulate-us","kind":"trial","name":"CIRCULATE-US","route":"/trials/circulate-us/"},{"id":"dynamic-iii","kind":"trial","name":"DYNAMIC-III","route":"/trials/dynamic-iii/"},{"id":"quasar","kind":"trial","name":"QUASAR","route":"/trials/quasar/"},{"id":"tracc","kind":"trial","name":"TRACC","route":"/trials/tracc/"}],"person":[{"id":"jeanne-tie","kind":"person","name":"Jeanne Tie","route":"/people/jeanne-tie/"}],"paper":[{"id":"paper-reinert-ctdna-ultradeep-sequencing-colorectal-jama-oncol-2019","kind":"paper","name":"Analysis of plasma cell-free DNA by ultradeep sequencing in patients with stages I to III colorectal cancer","route":"/key-papers/paper-reinert-ctdna-ultradeep-sequencing-colorectal-jama-oncol-2019/"},{"id":"paper-tie-ctdna-minimal-residual-disease-stage-ii-colon-sci-transl-med-2016","kind":"paper","name":"Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer","route":"/key-papers/paper-tie-ctdna-minimal-residual-disease-stage-ii-colon-sci-transl-med-2016/"},{"id":"paper-dynamic-nat-med-2025-update","kind":"paper","name":"Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer: 5-year outcomes of the randomized DYNAMIC trial","route":"/key-papers/paper-dynamic-nat-med-2025-update/"},{"id":"paper-dynamic-nejm-2022","kind":"paper","name":"DYNAMIC: a blood test safely halved chemotherapy use after surgery for stage II colon cancer","route":"/key-papers/paper-dynamic-nejm-2022/"}],"idea":[{"id":"idea-bio2-national-mrd-platform","kind":"idea","name":"A national platform trial that every ctDNA-positive patient can join","route":"/ideas/idea-bio2-national-mrd-platform/"},{"id":"idea-moon-mrd-weather-service","kind":"idea","name":"A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled","route":"/ideas/idea-moon-mrd-weather-service/"},{"id":"idea-ctdna-guided-adjuvant-crc","kind":"idea","name":"ctDNA-guided adjuvant therapy as the default in stage II-III colon cancer","route":"/ideas/idea-ctdna-guided-adjuvant-crc/"},{"id":"idea-tr2-ctdna-mrd-qualification","kind":"idea","name":"Formally qualify tumour-DNA blood tests as a surrogate endpoint for adjuvant trials","route":"/ideas/idea-tr2-ctdna-mrd-qualification/"},{"id":"idea-bio2-platelet-cloak-aspirin-mrd","kind":"idea","name":"Strip the platelet coat off travelling tumour cells in ctDNA-positive patients","route":"/ideas/idea-bio2-platelet-cloak-aspirin-mrd/"},{"id":"idea-crc-ctdna-de-escalation-beyond-stage-ii","kind":"idea","name":"Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps","route":"/ideas/idea-crc-ctdna-de-escalation-beyond-stage-ii/"},{"id":"idea-tr1-ctdna-guided-stop-in-metastatic-disease","kind":"idea","name":"Use tumour DNA in blood to decide when to pause treatment in metastatic cancer","route":"/ideas/idea-tr1-ctdna-guided-stop-in-metastatic-disease/"}],"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"},{"id":"colorectal-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/colorectal-roadmap/"},{"id":"ctdna-tests","kind":"roadmap","name":"ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment","route":"/roadmaps/ctdna-tests/"},{"id":"diagnostics-roadmap","kind":"roadmap","name":"Diagnostics roadmap: stains → gene panels → blood tests that decide treatment","route":"/roadmaps/diagnostics-roadmap/"},{"id":"trial-modernisation-roadmap","kind":"roadmap","name":"Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on","route":"/roadmaps/trial-modernisation-roadmap/"}],"pairing":[{"id":"ctdna-mrd-to-adjuvant","kind":"pairing","name":"ctDNA MRD → adjuvant therapy decision","route":"/pairings/ctdna-mrd-to-adjuvant/"}],"bottleneck":[{"id":"b-dormancy-mrd","kind":"bottleneck","name":"Dormant cells and minimal residual disease","route":"/bottlenecks/b-dormancy-mrd/"},{"id":"b-metastasis-biology","kind":"bottleneck","name":"Metastasis is understood least and studied last","route":"/bottlenecks/b-metastasis-biology/"}],"pathway":[{"id":"clonal-evolution","kind":"pathway","name":"Clonal evolution & minimal residual disease","route":"/pathways/clonal-evolution/"}],"company":[{"id":"agitg","kind":"company","name":"Australasian Gastro-Intestinal Trials Group","route":"/companies/agitg/"}]}}