Dynamic Circulating Tumor DNA Methylation Monitoring Guiding Postoperative Surveillance in Nonmetastatic Colorectal Cancer: A Prospective, Randomized, Phase III FIND Trial.
Shaobo Mo, Chaoqiang Zhou, Maoguang Ma et al.
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In 30 seconds
The prospective, multicenter, randomized phase III FIND trial compared circulating tumor DNA (ctDNA) methylation-guided surveillance with standard CT monitoring after curative resection of nonmetastatic colorectal cancer. Among 584 eligible patients, recurrence rates were similar, but curative-intent treatment for recurrence was more frequent with ctDNA-guided surveillance (48.1% vs 23.6%; relative risk 2.03, P = .008). Clinical recurrence was detected earlier in the ctDNA-guided group, with a median time of 9.5 versus 13.4 months. The authors note that a long-term survival benefit remains to be established.
Key findings
- Recurrence rates were similar with ctDNA-guided and standard surveillance: 18.0% v 18.6% (P = .919).
- Curative-intent treatment occurred in 48.1% v 23.6% of patients with recurrence (relative risk 2.03, P = .008).
- Median time to clinical recurrence was 9.5 v 13.4 months (P < .001), a lead time of 3.9 months.
- For liver and/or lung recurrences, curative resection rates were 42.3% v 18.2% (P = .002).
Why it matters
Earlier identification of recurrence may increase the opportunity to treat selected metastases with curative intent, even when overall recurrence rates are unchanged. The trial provides randomized evidence that a ctDNA-informed surveillance approach can alter detection timing and treatment patterns after colorectal cancer resection. Whether these changes improve long-term survival remains unresolved.
What to keep in mind
Median follow-up was 23.3 months, and long-term survival benefit has not yet been established; the authors state that validation awaits future analyses with mature data.