Tumor-Free Circulating Tumor DNA in Node-Negative Rectal Cancers Undergoing Neoadjuvant Chemotherapy, Excision, and Observation in the Phase II NEO Trial (CO.28).
JCO Precis OncolOct 2, 2026 (epub)
Jonathan M Loree, Emma Titmuss, Carl J Brown et al.
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In 30 seconds
The Phase II NEO trial investigated the role of circulating tumor DNA (ctDNA) in guiding treatment decisions for 53 patients with node-negative rectal cancer undergoing neoadjuvant chemotherapy and transanal excision. The study found that ctDNA detection decreased significantly from 45.8% pre-chemotherapy to 8.7% post-chemotherapy (P < .0001), indicating its potential as a decision aid for organ preservation.
Key findings
- ctDNA was detected in 45.8% of patients before neoadjuvant chemotherapy.
- Post-chemotherapy, detectable ctDNA decreased to 8.7% (P < .0001).
- 100% of patients with detectable ctDNA post-chemotherapy were recommended for TME, compared to 38.1% with undetectable ctDNA.
- 50% of patients with recurrence had detectable ctDNA at progression.
Why it matters
The findings suggest that ctDNA analysis could serve as a valuable tool in assessing treatment response in early-stage rectal cancer, potentially guiding decisions on organ preservation and reducing the need for invasive procedures.