Oncology ·
ctDNA-Guided Surveillance Increased Curative-Intent Treatment After Colorectal Cancer Recurrence
In the randomized, phase III FIND trial, 584 patients with nonmetastatic colorectal cancer were assigned to ctDNA methylation-guided or standard CT-based surveillance after curative resection. The ctDNA-guided strategy was associated with more curative-intent treatment for recurrence, while recurrence rates were similar between groups.
- Randomized trial enrolled 584 patients after colorectal cancer resection.
- Curative-intent treatment was more frequent with ctDNA-guided surveillance.
- Recurrence rates were similar between groups.
- Long-term survival benefit remains unconfirmed.
The multicenter FIND trial (NCT05904665) randomly assigned patients with nonmetastatic colorectal cancer after curative resection to dynamic circulating tumor DNA (ctDNA) methylation-guided surveillance or standard CT-based monitoring. In the ctDNA-guided group, a positive test prompted immediate CT imaging; quarterly ctDNA testing continued alongside bimonthly CT, with imaging returning to standard frequency after two consecutive negative tests. The primary endpoint was the proportion of patients with recurrence who received curative-intent metastasis-directed treatment.
Among 584 patients in the modified intention-to-treat analysis (289 ctDNA-guided and 295 controls), median follow-up was 23.3 months. Recurrence rates were similar (18.0% vs 18.6%), but curative-intent treatment was more frequent with ctDNA-guided surveillance (48.1% vs 23.6%; relative risk 2.03; P = .008). Median time to clinical recurrence was 9.5 versus 13.4 months, a 3.9-month difference. Among patients with liver- and/or lung-confined recurrence, curative resection rates were 42.3% versus 18.2%.
The findings suggest earlier detection may increase opportunities for curative-intent treatment, but the trial abstract reports no mature survival benefit. Longer follow-up is needed to establish whether the strategy improves survival; the results alone do not establish that surveillance should change.
In practice
For patients with initially nonmetastatic colorectal cancer after curative resection, this randomized phase III trial found that dynamic ctDNA methylation-guided surveillance was associated with more curative-intent treatment for recurrence than standard CT-based monitoring. Recurrence rates were similar, and earlier clinical detection may have contributed to the difference. These findings are promising but do not establish a survival benefit; longer follow-up is needed before concluding that this approach should replace standard surveillance.
AI-generated clinical interpretation · Not editor-reviewed
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Journal of Clinical Oncology: Dynamic Circulating Tumor DNA Methylation Monitoring Guiding Postoperative Surveillance in Nonmetastatic Colorectal Cancer: A Prospective, Randomized, Phase III FIND Trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.