Molecular Residual Disease-guided Adjuvant Treatment in Resected Colorectal Cancer: Focus on CIRCULATE-Japan

The body of evidence supporting the utility of the detection of molecular residual disease (MRD) in resected colorectal cancer (CRC) using circulating tumor DNA (ctDNA) analysis is rapidly growing. Furthermore, this evidence provides the rationale for escalation and de-escalation adjuvant chemotherapy (ACT) strategies using ctDNA MRD analysis. This has led to various randomized clinical trials, and CIRCULATE-Japan is one of the largest of these trial platforms. In this review, we provide an overview of the potential utility of ctDNA-based MRD detection for escalation and de-escalation ACT approaches. Furthermore, we highlight the feasibility using ctDNA clearance as a surrogate endpoint for ACT trials in patients with resected CRC, based on findings of the CIRCULATE-Japan project.

Automated summary

The body of evidence supporting the utility of ctDNA analysis for detecting MRD in resected CRC is rapidly growing, leading to the development of escalation and de-escalation ACT strategies. The CIRCULATE-Japan project is one of the largest randomized clinical trials investigating this approach. This review provides an overview of the potential utility of ctDNA-based MRD detection for guiding ACT in patients with resected CRC, with a focus on the findings from the CIRCULATE-Japan project.