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ESMO 2025 | MRD assessment & ctDNA monitoring to guide treatment post-surgery in GI cancer
Filippo Pietrantonio, MD, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, discusses the role of minimal residual disease (MRD) assessment and circulating tumor DNA (ctDNA) monitoring in guiding treatment escalation or de-escalation strategies after surgery, highlighting the increasing amount of data available for ctDNA in colorectal cancer, with trials such as PEGASUS (NCT04259944) and DYNAMIC (ACTRN12615000381583) providing valuable insights. Dr Pietrantonio emphasizes the need for larger studies, prospective observational studies, and randomized clinical trials to fully establish the clinical utility of liquid biopsy in guiding treatment decisions, particularly in gastric cancer where data is currently limited. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
This is a very good question. So for ctDNA we are really ready for prime time in colorectal cancer because the amount of data available for the use of ctDNA to guide escalation and de-escalation is increasing and at this meeting we have seen two different trials presented. The PEGASUS trial was presented yesterday and during the presidential symposium tomorrow we will see the DYNAMIC trial data presented from Australia presented by Jean-Tierre and so this is adding knowledge to the role of ctDNA after surgery...
This is a very good question. So for ctDNA we are really ready for prime time in colorectal cancer because the amount of data available for the use of ctDNA to guide escalation and de-escalation is increasing and at this meeting we have seen two different trials presented. The PEGASUS trial was presented yesterday and during the presidential symposium tomorrow we will see the DYNAMIC trial data presented from Australia presented by Jean-Tierre and so this is adding knowledge to the role of ctDNA after surgery. Regarding gastric cancer, the amount of available data is lower. So we really need to study larger samples to do prospective observational studies to do clinical trials and potentially randomized clinical trials. This is exactly the same for colorectal cancer because for example trials like the DYNAMIC trial randomized to the use versus non-use of liquid biopsy in the post-operative setting but what we really want to see in the future is the use of liquid biopsy to select patients but then randomization to different strategies and so liquid biopsy is a useful tool but we need randomized trials to demonstrate if it is clinically useful and also it’s improving the outcome of patients thanks to novel strategies applied to the post-operative setting. So I think that also we are seeing an improvement of the sensitivity and specificity of the assays used nowadays compared to the past. And so we will have to improve the technology with time and also the trial design. And we will reach the point where we will really use liquid biopsy to escalate or de-escalate and personalize the treatment choices based on the patient profile, which is really what we want to do based on the concept of precision medicine, sparing unnecessary toxicity to patients cured by surgery, for example, and intensify and offer novel options to those patients who may really face disease recurrence over time.
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