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ASCO 2026 | INTERCEPT: stage-specific ctDNA positivity and MRD decision-making in CRC
Emerik Osterlund, MD, PhD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses stage-specific circulating tumor DNA (ctDNA) positivity rates and associated clinical decision-making in the INTERCEPT program, a prospective study in patients with colorectal cancer (CRC) undergoing curative-intent procedures. ctDNA positivity confirmed its prognostic value for recurrence across disease stages and meaningfully influenced clinical management, including diagnostic workup and minimal residual disease (MRD) trial enrollment, though heterogeneity in management approaches was observed even within a single center. This interview took place during the 2026 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
We looked at the real-world INTERCEPT cohort at MD Anderson and specifically looked at stage and how many were positive by stage and over time. And then the second part considered the first action taken in the MRD window, so where patients were ctDNA positive but without any visible radiologic disease. So in the first part, looking at the different stages, we saw higher ctDNA positivity rates in higher stages with 39% at curative intent treatment completion...
We looked at the real-world INTERCEPT cohort at MD Anderson and specifically looked at stage and how many were positive by stage and over time. And then the second part considered the first action taken in the MRD window, so where patients were ctDNA positive but without any visible radiologic disease. So in the first part, looking at the different stages, we saw higher ctDNA positivity rates in higher stages with 39% at curative intent treatment completion. So it was 39% in stage 4 and 7% in stage one and stages two and three were sort of gradually in between those. And if we sort of looked at later time points, we saw that these positivity rates also got lower over time, going down from 39% to 17% in stage four and from 7% to 3% in stage 1. So like a clear connection with stage and time on how many were ctDNA positive. And then for a subset of the patients that became ctDNA positive without having radiologic recurrences. We also looked at the first action taken in that window and MRD trial screening was done for 22% as the initial step. For 28% you did diagnostic work-up with MRI, PET or a biopsy to get a better picture of is there any disease or not. Then the rest of them, 8% received maintenance therapy of protocol and then the rest of them either had earlier follow-up or regular follow-up continued without any change. And then MRD trials in total were discussed with 53%. And these data sort of highlight both the sort of connection with ctDNA positivity time and stage, and then also highlight how heterogeneous the management can be in the ctDNA window, even within one institution.
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