Circulating tumour DNA-guided adjuvant chemotherapy in colorectal carcinoma
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memo https://doi.org/10.1007/s12254-020-00607-y
Circulating tumour DNA-guided adjuvant chemotherapy in colorectal carcinoma Andreas Reichinger · Holger Rumpold
Received: 9 February 2020 / Accepted: 31 March 2020 © Springer-Verlag GmbH Austria, part of Springer Nature 2020
Summary Approximately 20% of locoregional colorectal carcinoma (CRC) relapse after standard of care treatment. Therefore, it is necessary to personalize our adjuvant strategies and define this subgroup, which remains at high risk after treatment. Circulating tumour DNA (ctDNA) is cell-free DNA from apoptotic cancer cells, which carries the whole genome information of the primary tumour and has emerged as good candidate to guide our therapy decisions in the future. It was shown that high levels of ctDNA after adjuvant chemotherapy is a poor prognostic factor. Moreover, it was presented at ESMO 2019 in Barcelona that patients with advanced colorectal carcinomas and ctDNA-positive samples after surgery had a significantly decreased 2-year disease-free survival in comparison to ctDNA-negative patients. That means, ctDNA could be a tool to select this highrisk subgroup in advanced CRC in order to prolong or intensify adjuvant chemotherapy and to avoid insufficient treatment.
agnosed carcinoma in the world. Approximately 80% are in localized or regional stage at diagnosis. In this stadium surgery is the only curative modality. The 5-year disease-specific conditional survival probability is ≥80% for all disease stages except stage IV (12%) [1]. In stage II approximately 80% of patients are cured with surgery alone, compared to stage III with only 69%. Administering adjuvant chemotherapy reduces the risk of death, by absolute 3–5% in stage II with singleagent 5-fluorouracil (5-FU) and 15–20% in stage III with 5-FU and oxaliplatin combination [2, 3]. Nevertheless, after guideline-conform therapy, there are still patients who relapse. Although we can reduce this risk, we have no markers in our current standard to define this group of patients who remain at high risk after treatment. Therefore, we need posttherapeutic or even pretherapeutic markers to identify this high-risk subset.
Circulating tumour DNA Keywords Colorectal carcinoma · Circulating tumour DNA · Adjuvant therapy · Diagnostic
Introduction Colorectal carcinoma (CRC) is the third leading cause of cancer death and the fourth most commonly diA. Reichinger, MD () Department of Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria [email protected]
Circulating tumour DNA (ctDNA) is cell-free DNA from apoptotic or necrotic cancer cells which is released in the systemic circulation and is now evolving from research to clinical use. Single- or doublestranded DNA can be found in the blood but also in other body fluids like synovial or cerebrospinal fluid [4]. It was shown in previous studies that ctDNA carries the whole heterogeneous information of the primary tumour and m
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