Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Division of Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Cancer Treat Rev. 2024 May;126:102735. doi: 10.1016/j.ctrv.2024.102735. Epub 2024 Apr 4.
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.
由于结肠癌有很高的肿瘤碎片脱落进入血液的比率，因此目前有几项研究工作集中在通过检测 ctDNA 来检测微小残留疾病，以调整结肠癌患者的辅助治疗，并优化其成本效益平衡。在结肠癌根治性手术后患者血液中可检测到 ctDNA 对预后有明显的负面影响。目前正在进行几项采用不同设计和技术的临床试验，旨在通过回答五个一般问题将这些承诺转化为临床实践：i）ctDNA 指导的决策是否对结肠癌患者的术后管理有效？ii）ctDNA 阴性病例是否可以采用降级策略？iii）升级策略是否有助于改善 ctDNA 阳性患者的预后？iv）在辅助化疗结束时发现 MRD 时，另一种辅助系统治疗是否有效？v）我们能否在结肠癌患者的随访中利用 ctDNA 技术？这篇综述重点介绍了目前正在进行的试验，以及它们的结果如何影响早期结肠癌的 ctDNA“液体革命”。
