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GI Malignancies Debate 2023 - Chicago | Ongoing clinical trials on using ctDNA results to guide GI cancer management

Suneel Kamath, MD, Cleveland Clinic, Cleveland, OH, outlines two key ongoing clinical trials pertaining to the use of ctDNA testing in GI cancer management. The first, COBRA (NCT04068103), is focused on patients with stage II colon cancer following resection. This study compares the standard approach of surveillance with treatment guided by ctDNA results. Patients with negative ctDNA results undergo the standard surveillance approach, while those with positive ctDNA results receive chemotherapy. The second study of interest, CIRCULATE-US (NCT05174169), observes whether ctDNA-negative patients with low-risk stage III colon cancer can safely avoid chemotherapy treatment, while those with a positive ctDNA result receive escalated chemotherapy. Another arm of this study observes the effectiveness of specific biomarker-targeted therapies in cases where patients present with tumor mutations such as RAS, BRAF or MSI, and remain ctDNA-positive after adjuvant chemotherapy. For these patients, recurrence is highly likely but completing additional rounds of chemotherapy may not be of any benefit. Therefore, implementing biomarker-specific therapies, such as immunotherapy for MSI-high patients, may be of some value. This interview took place at the Great Debates and Updates GI Malignancies Debate in Chicago, IL.

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