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Tailoring adjuvant chemotherapy by circulating tumor DNA (ctDNA) in older patients with stage II-III colon cancer

Published:August 26, 2022DOI:https://doi.org/10.1016/j.jgo.2022.08.016
      Colorectal cancer is the third most frequent cancer worldwide and the fourth most common cause of cancer mortality [
      • Arnold M.
      • et al.
      Global patterns and trends in colorectal cancer incidence and mortality.
      ]. The average age of patients with colorectal cancer in Western countries is around 70 years old [
      • Siegel R.L.
      • Miller K.D.
      • Jemal A.
      Cancer statistics, 2016.
      ]. Surgery is the current gold standard for treating early-stage colon cancer, with adjuvant chemotherapy (ACT) in most cases to improve cure rates [
      • Benson A.B.
      • et al.
      Colon cancer, version 2.2021, NCCN clinical practice guidelines in oncology.
      ]. The goal of ACT in patients with colon cancer is to increase the likelihood of cure while minimizing the risk of toxicity. The ACT is the standard of care in stage III colon cancer [
      • Shah M.A.
      • et al.
      Impact of patient factors on recurrence risk and time dependency of oxaliplatin benefit in patients with colon cancer: analysis from modern-era adjuvant studies in the adjuvant colon cancer end points (ACCENT) database.
      ], while in stage II disease, additional clinical risk factors are used to optimize patient selection for adjuvant treatment [
      • Labianca R.
      • et al.
      Early colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.
      ]. Furthermore, the risk of toxicity is an important concern in aiding adjuvant treatment selection for individual patients.

      Keywords

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      References

        • Arnold M.
        • et al.
        Global patterns and trends in colorectal cancer incidence and mortality.
        Gut. 2017; 66: 683-691
        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2016.
        CA Cancer J Clin. 2016; 66: 7-30
        • Benson A.B.
        • et al.
        Colon cancer, version 2.2021, NCCN clinical practice guidelines in oncology.
        J Natl Compr Cancer Netw. 2021; 19: 329-359
        • Shah M.A.
        • et al.
        Impact of patient factors on recurrence risk and time dependency of oxaliplatin benefit in patients with colon cancer: analysis from modern-era adjuvant studies in the adjuvant colon cancer end points (ACCENT) database.
        J Clin Oncol. 2016; 34: 843
        • Labianca R.
        • et al.
        Early colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2013; 24 (vi64-72)
        • Millan M.
        • et al.
        Treatment of colorectal cancer in the elderly.
        World J Gastrointest Oncol. 2015; 7: 204
        • Hoshino N.
        • et al.
        Impact of venous invasion on the efficacy of adjuvant chemotherapy in elderly patients with stage III colorectal cancer.
        Med Oncol. 2017; 34: 1-6
        • Nitsche U.
        • Stöss C.
        • Friess H.
        Effect of adjuvant chemotherapy on elderly colorectal cancer patients: lack of evidence.
        Gastroint Tumors. 2017; 4: 11-19
        • Holm M.
        • et al.
        Detection of KRAS mutations in liquid biopsies from metastatic colorectal cancer patients using droplet digital PCR, Idylla, and next generation sequencing.
        PLoS One. 2020; 15e0239819
        • Raja R.
        • et al.
        Early reduction in ctDNA predicts survival in patients with lung and bladder Cancer treated with Durvalumab.
        Clin Cancer Res. 2018; 24: 6212-6222
        • Xu R.H.
        • et al.
        Circulating tumour DNA methylation markers for diagnosis and prognosis of hepatocellular carcinoma.
        Nat Mater. 2017; 16: 1155-1161
        • Chen M.
        • Zhao H.
        Next-generation sequencing in liquid biopsy: cancer screening and early detection.
        Hum Genomics. 2019; 13: 1-10
        • Cheng F.T.-F.
        • et al.
        Liquid biopsy detects relapse five months earlier than regular clinical follow-up and guides targeted treatment in breast cancer.
        Case Rep Oncol Med. 2019; https://doi.org/10.1155/2019/6545298
        • Reinert T.
        • et al.
        Analysis of plasma cell-free DNA by Ultradeep sequencing in patients with stages I to III colorectal Cancer.
        JAMA Oncol. 2019; 5: 1124-1131
        • Tarazona N.
        • et al.
        Targeted next-generation sequencing of circulating-tumor DNA for tracking minimal residual disease in localized colon cancer.
        Ann Oncol. 2019; 30: 1804-1812
        • Tie J.
        • et al.
        Circulating tumor DNA analyses as markers of recurrence risk and benefit of adjuvant therapy for stage III colon cancer.
        JAMA Oncol. 2019; 5: 1710-1717
        • Gill S.
        • et al.
        Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much?.
        J Clin Oncol. 2004; 22: 1797-1806
        • André T.
        • et al.
        Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial.
        J Clin Oncol. 2009; 27: 3109-3116
        • Sargent D.J.
        • et al.
        A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients.
        N Engl J Med. 2001; 345: 1091-1097
        • Sanoff H.K.
        • et al.
        Effect of adjuvant chemotherapy on survival of patients with stage III colon cancer diagnosed after age 75 years.
        J Clin Oncol. 2012; 30: 2624
        • Kuebler J.P.
        • et al.
        Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07.
        J Clin Oncol. 2007; 25: 2198-2204
        • McCleary N.J.
        • et al.
        Impact of age on the efficacy of newer adjuvant therapies in patients with stage II/III colon cancer: findings from the ACCENT database.
        J Clin Oncol. 2013; 31: 2600
        • Haller D.
        • et al.
        Impact of age and medical comorbidity on adjuvant treatment outcomes for stage III colon cancer: a pooled analysis of individual patient data from four randomized, controlled trials.
        Ann Oncol. 2015; 26: 715-724
        • Papamichael D.
        • et al.
        Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013.
        Ann Oncol. 2015; 26: 463-476
        • Dotan E.
        • et al.
        Challenges in the management of older patients with colon cancer.
        J Natl Compr Cancer Netw. 2012; 10 ([quiz 225]): 213-224
        • Wildiers H.
        • et al.
        International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer.
        J Clin Oncol. 2014; 32: 2595-2603
        • Extermann M.
        • et al.
        Predicting the risk of chemotherapy toxicity in older patients: the chemotherapy risk assessment scale for high-age patients (CRASH) score.
        Cancer. 2012; 118: 3377-3386
        • Hurria A.
        • et al.
        Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study.
        J Clin Oncol. 2011; 29: 3457
        • Angeli E.
        • et al.
        Development, validation and clinical impact of a prediction model for 6-month mortality in older cancer patients: the GRADE.
        Aging (Albany NY). 2020; 12: 4230-4246
        • Ferrat E.
        • et al.
        Performance of four frailty classifications in older patients with Cancer: prospective elderly Cancer patients cohort study.
        J Clin Oncol. 2017; 35: 766-777
        • Bardia A.
        • et al.
        Adjuvant chemotherapy for resected stage II and III colon cancer: Comparison of two widely used prognostic calculators.
        in: Seminars in oncology. Elsevier, 2010
        • Papamichael D.
        • et al.
        Validity of adjuvant! Online in older patients with stage III colon cancer based on 2967 patients from the ACCENT database.
        J Geriatr Oncol. 2016; 7: 422-429
        • Guven D.C.
        • et al.
        A systematic review and meta-analysis of the association between circulating tumor DNA (ctDNA) and prognosis in pancreatic cancer.
        Crit Rev Oncol Hematol. 2021; 168103528
        • Berger A.W.
        • et al.
        Treatment monitoring in metastatic colorectal cancer patients by quantification and KRAS genotyping of circulating cell-free DNA.
        PLoS One. 2017; 12e0174308
        • Diehl F.
        • et al.
        Circulating mutant DNA to assess tumor dynamics.
        Nat Med. 2008; 14: 985-990
        • Osumi H.
        • et al.
        Early change in circulating tumor DNA as a potential predictor of response to chemotherapy in patients with metastatic colorectal cancer.
        Sci Rep. 2019; 9: 17358
        • Tie J.
        • et al.
        Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer.
        Sci Transl Med. 2016; 8: 346ra92
        • Tie J.
        • et al.
        Circulating tumor DNA analysis guiding adjuvant therapy in stage II Colon Cancer.
        N Engl J Med. 2022; 386: 2261-2272https://doi.org/10.1056/NEJMoa2200075
        • Papamichael D.
        • et al.
        Adjuvant chemotherapy in patients with colorectal cancer. Is there a role in the older adult?.
        Eur J Surg Oncol. 2020; 46: 363-368
        • Bent A.
        • et al.
        The future of ctDNA-defined minimal residual disease: personalizing adjuvant therapy in CRC.
        Clin Colorectal Cancer. 2022; 21: 85-89https://doi.org/10.1016/j.clcc.2022.03.004