Zie ook in gerelateerde artikelen onder ctDNA

28 januari 2025: Bron: Science Direct, Published online April 3, 2024

Omdat er in het bloed bij vormen van darmkanker waaronder vooral dikke darmkanker en endeldarmkanker vaak tumor DNA is te vinden hebben ctDNA bloedtesten vaak een meerwaarde bij het vaststellen van een gepersonaliseerde behandeling en is ook met ctDNA bloedtesten vast te stellen of een behandeling aanslaat. Er lopen dan ook wereldwijd verschillende studies. 

In Sciende Direct werd vorig jaar een overzichtstudie gepubliceerd van de stand van zaken van ctDNA bloedtesten bij vormen van darmkanker, met ook een verwijzing en korte beschrijving naar lopende grote studies. Het studieverslag is lang maar interessant door de opsplitsing in verschillende inmvalshoeken zoals of er wel of geen tumor DNA in het bloed is gevonden, of vooraf en na een operatie of ter controle van lopende behandeling enz.  

Een vertaling van de kernpunten uit deze studiepublicatie:

  • Het optimaliseren van de identificatie van patiënten die adjuvante chemotherapie moeten krijgen, is een grote uitdaging bij vroege vormen van darmkanker.
  • Het gebruik van een vloeibare biopsie om circulerend tumor-DNA (ctDNA) te detecteren als een marker van minimale restziekte is de afgelopen jaren met grote toenemende interesse getoond.
  • Verschillende lopende onderzoeken gebruiken ctDNA-analyse om adjuvante behandeling te begeleiden naar de-escalatie-/escalatiestrategieën in ctDNA-negatieve en ctDNA-positieve gevallen.
  • Sommige onderzoeken onderzoeken de rol van post-adjuvante systemische therapieën bij ctDNA-positieve patiënten na voltooiing van de adjuvante behandeling.
  • Vanwege het vermogen om terugkeer van de ziekte vroegtijdig te detecteren, onderzoeken sommige onderzoeken ctDNA-geleide bewaking tijdens de follow-up van geopereerde darmkankerpatiënten.
Het volledige studierapport is gratis in te zien met ook links naar lopende studies. Klik daarvoor op de titel van het abstract:

Review ArticleVolume 126102735May 2024Open access

Waiting for the “liquid revolution” in the adjuvant treatment of colon cancer patients: a review of ongoing trials

Publication History:
Received December 1, 2023Revised April 2, 2024Accepted April 3, 2024Published online April 3, 2024
Copyright: © 2024 The Author(s). Published by Elsevier Ltd.
Cover Image - Cancer Treatment Reviews, Volume 126, Issue undefined

Highlights

Optimising the identification of patients who should receive adjuvant chemotherapy is a major challenge in early colorectal cancer.
The use of liquid biopsy to detect circulating tumor DNA (ctDNA) as a marker of minimal residual disease has been shown with dramatically growing interest in the last years.
Several ongoing trials are using ctDNA analysis to guide adjuvant treatment to de-escalation/escalation strategies in ctDNA-negative/ ctDNA-positive cases.
Some trials are investigating the role of post-adjuvant systemic therapies in ctDNA-positive patients after adjuvant treatment completion.
Due to its ability to early detect disease recurrence, some trials are investigating ctDNA-guided surveillance during follow-up of resected colorectal cancer patients.

Abstract

Since colon cancer has a high rate of shedding of tumour fragments into the blood, several research efforts are now focused on the investigation of the minimal residual disease through the detection of ctDNA to tailor the adjuvant therapy of colon cancer patients and optimize its cost/effectiveness balance. The negative prognostic impact of detectable ctDNA in patients’ blood after radical surgery for colon cancer is well established. Several clinical trials adopting heterogeneous designs and techniques are now ongoing to translate promises into daily practice by answering five general questions: i) is a ctDNA-guided decision making efficacious in the post-operative management of colon cancer patients? ii) are de-escalation strategies possible in ctDNA-negative cases? iii) are escalation strategies useful to improve the prognosis of ctDNA-positive patients? iv) when MRD is identified at the end of the adjuvant chemotherapy, is another post-adjuvant systemic therapy efficacious? v) can we exploit ctDNA technologies in the follow up of colon cancer patients? This review focuses on currently ongoing trials and how their results may affect the ctDNA “liquid revolution” of early colon cancer.

CRediT authorship contribution statement

V. Conca: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. P. Ciracì: Conceptualization, Data curation, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing. C. Boccaccio: Conceptualization, Data curation, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing. A. Minelli: Data curation, Investigation, Methodology, Resources, Software, Validation, Writing – original draft. C. Antoniotti: Conceptualization, Formal analysis, Investigation, Project administration, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. C. Cremolini: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [C.C.: honoraria—Amgen, Bayer, Merck, Roche and Servier. Consulting or advisory role—Amgen, Bayer, MSD, Roche. Speakers’ Bureau— Servier. Research funding—Bayer, Merck, Servier. Travel, accommodations and expenses—Roche and Servier. All other authors declare no conflicts of interest.].

Acknowledgements

The research leading to these results has received funding from the European Union - NextGenerationEU through the Italian Ministry of University and Research under PNRR - M4C2-I1.3 Project PE_00000019 “HEAL ITALIA” to Chiara Cremolini CUP: I53C22001440006. The views and opinions expressed are those of the authors only and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them.

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