Loading
Showed that a blood test can safely halve the number of colon cancer patients given chemotherapy after surgery.
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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
455 enrolled.
Non-inferiority met (margin −8.5 points)
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Recurrence-free survival at 2 years (non-inferiority)primary | ctDNA-guided management | 302 | 93.5% | - | - | link |
| Standard management | 153 | 92.4% | ||||
| Patients receiving adjuvant chemotherapy | ctDNA-guided management | - | 15% | - | <0.001 | link |
| Standard management | - | 28% |
A second publication from the DYNAMIC trial, later than the first and described in its title as an update or longer-term analysis. Read it with the primary publication linked from the trial page; the record was linked automatically and its figures have not been checked by hand.
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.
It showed that serial rather than single testing is what makes residual disease detection work, and it set the sampling schedule most later studies have used.
Minimal residual disease became measurable in solid tumours, and the DYNAMIC and CIRCULATE trials that followed turned the measurement into a treatment decision.
Shares SMART design (sequential multiple assignment randomised trial), Use tumour DNA in blood to decide when to pause treatment in metastatic cancer, A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled, A national platform trial that every ctDNA-positive patient can join.
Shares Jeanne Tie, ctDNA-guided adjuvant therapy as the default in stage II-III colon cancer, Formally qualify tumour-DNA blood tests as a surrogate endpoint for adjuvant trials, Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps.
Shares A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled, Analysis of plasma cell-free DNA by ultradeep sequencing in patients with stages I to III colorectal cancer, ALTAIR, Jeanne Tie.
Shares ALTAIR, DYNAMIC-III, CIRCULATE-US, Tumour-informed versus tumour-naive ctDNA assays.
Shares Use tumour DNA in blood to decide when to pause treatment in metastatic cancer, CIRCULATE-US, Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps, ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment.
Shares Tumour-informed versus tumour-naive ctDNA assays, Diagnostics roadmap: stains → gene panels → blood tests that decide treatment, ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment, Minimal / molecular residual disease (MRD).
Shares A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled, ctDNA MRD → adjuvant therapy decision, Dormant cells and minimal residual disease, Minimal / molecular residual disease (MRD).
Shares Tumour-informed versus tumour-naive ctDNA assays, Diagnostics roadmap: stains → gene panels → blood tests that decide treatment, ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment, Minimal / molecular residual disease (MRD).