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Ibrahim Halil Sahin: The role of ctDNA for the management of patients with early stage colon cancer

Ibrahim Halil Sahin/X

Jan 30, 2025, 17:24

Ibrahim Halil Sahin: The role of ctDNA for the management of patients with early stage colon cancer

Ibrahim Halil Sahin, Assistant Professor at UPMC Hillman Cancer Center, shared on LinkedIn:

“Our paper discussing the role of ctDNA for the management of patients with early stage colon cancer is now out

CtDNA is rapidly evolving and it is here to stay

In this article we discussed the pros and cons of ctDNA and it is relevance to personalized adjuvant therapy

Here are some key points.

Our current approaches for adjuvant therapy relies on pathological staging of colon cancer which lacks precision

Approximately 60% patients with stage III colon cancer actually are cured by surgery alone and we don’t know who they are

Moreover, the benefit of chemotherapy even for patients with stage III colon cancer is ~15-20% and that’s only 5% for stage II.

In other words, we are treating many patients with chemotherapy who actually don’t need chemotherapy as our pathological staging lacks the precision

So, ctDNA is an opportunity to personalize adjuvant therapy and provide more precision recommendations based on determination of minimal residual disease.

However, at this time, most evidence we have (except the Dynamic trial for stage II colon cancer) comes from observation studies

We need interventional randomized clinical trials to be able to prove what was seen in prospective cohort studies ctDNA is developing technology

One time testing is insufficient and carries limitation for false negative result which improves with repeated testing

If ctDNA is proven to be reliable for adjuvant decision then several ongoing trials for neoadjuvant therapy for colon cancer will face major hurdles : significant over treatment

Current radiological technology for clinical staging of colon cancer is way far from optimal to have reliable match with pathological staging (gold standard) and the gold standard itself lacks the precision for determination of adjuvant therapy

So, neoadjuvant approaches may end up being out dated if ctDNA becomes a SOC in the future.

So, overall, ctDNA has potentials to revolutionize our adjuvant therapy if proven in ongoing prospective trials and may impact evolution of future designs of clinical trials for patients with early stage colon cancer utilizing novel agents

Shedding Light on the Prognostic and Predictive Value of Circulating Tumor DNA for Management of Patients with Early-Stage Colon Cancer – Rami Yanes, Turcin Saridogan, Vikram Gorantla, Abigail Overacre, Ronan W. Hsieh, James Celebrezze, Tara Magge, Meghana Singhi, Anwaar Saeed, Amer H. Zureikat, Arvind N. Dasari, Ibrahim Halil Sahin, 2025. ”

Ibrahim Halil Sahin: The role of ctDNA for the management of patients with early stage colon cancer