ASCO GI 2022 | CIRCULATE-US: investigating the use of ctDNA to detect MRD

Arvind Dasari, MD, MS, The University of Texas MD Anderson Cancer Center, Houston, TX, outlines the CIRCULATE (NCT04089631) study, an international collaboration investigating the use of ctDNA to detect minimal residual disease (MRD), that can otherwise not be detected by scans, to guide treatment strategies for patients with colon cancer. CIRCULATE-US is part of the CIRCULATE study and is a Phase II/III trial consisting of approximately 2,000 patients from the US with stage II or III colon cancer following curative resection. Patients who are identified as MRD-negative postoperatively by the Natera Signatera assay will be randomized to receive either immediate adjuvant chemotherapy per established guidelines or serial ctDNA monitoring. Patients undergoing ctDNA monitoring will commence chemotherapy if and when they test ctDNA-positive. Patients who are initially established as MRD-positive following surgery will be randomized to receive either the current SOC for adjuvant chemotherapy or more intensive chemotherapy to understand whether intensifying chemotherapy will improve outcomes in this patient population. The primary outcome for patients who are ctDNA-negative in the Phase II study is time to ctDNA positivity and disease-free survival (DFS) in the Phase III trial. For patients who ctDNA-positive, the primary endpoint is DFS for both Phase II and Phase III trials.This interview took place at the American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium 2022.