Using ctDNA for Earlier Detection and Treatment of Recurrence or Spread after Treatment for Stage 3 Colon Cancer
Using ctDNA Blood Test for Earlier Detection and Treatment of Recurrence or Spread after Treatment for Stage 3 Colon Cancer
About the Study
The usual care after a person with 3 colon cancer has had surgery and chemotherapy is to begin active surveillance. This is a time when no additional treatment is given, but instead patients have frequent imaging scans to see if their cancer has come back.
This study is looking at whether a blood test known as circulating tumor () can find signs of remaining cancer or recurrence after treatment earlier than standard active surveillance. People in the study who have evidence of cancer in their test may receive additional treatment based on their test results. All participants will receive close monitoring with imaging tests and blood tests. The goal of this study is to learn if using and additional treatment improves outcomes in people after treatment for 3 colon cancer. Currently, testing with and additional treatment based on results is not part of standard of care.
What the Study Involves
In order to participate, people in this study will receive a test to see if there is any evidence of cancer. People will be assigned to different screening and treatment groups based on the results of their test and their tumors. Participants will know which group they are in and what treatment they are receiving.
Based on the results of this pre-screening evaluation, participants will be placed into groups and will receive different treatments and follow up depending on which group they are in. Participants will be followed for 5 years.
For people whose pre-screening test shows no evidence of cancer cells in the bloodstream ( negative):
- People assigned to this group will receive active surveillance. They will have imaging and blood tests to look at tumor markers and every 3 months for a year. People who test ctDNA-positive during this time will be assigned to one of the study groups below based on their results.
For people whose pre-screening test shows evidence of cancer cells in the bloodstream ( positive):
People who are positive will be assigned to one of the groups below based on the presence or absence of additional tumor biomarkers.
- People who are positive for the following biomarkers will be assigned to the following groups and will receive additional treatment as described.
- MSI-H group: People who are positive, and have a tumor called MSI-H will receive additional treatments with the drug, Tecentriq (atezolizumab) weekly. Tecentriq is given as an IV (intravenous) injection every 4 weeks. Participants will receive up to 12 treatments.
- BRAF mutation group: People who are positive and have a tumor called a BRAF mutation will receive additional treatment with the oral targeted therapies, Braftovi (encorafenib) and Mektovi (binimetinib) every day for up to 24 weeks.
- group: People who are positive and have a tumor called , will receive a combination of Herceptin (trastuzumab) and Perjeta (pertuzumab) by iv injection every 3 weeks for up to 24 weeks.
- Participants who are positive but test negative for the additional biomarkers listed above will be randomly placed into one of two groups:
- Group 1 will receive additional cycles of FOLFIRI chemotherapy given by iv injection on days 1 and 3 of a 2-week cycle (every 2 weeks) for up to 24 weeks (12 cycles).
- Group 2 will receive active surveillance. For the first 6 months of the study, they will have imaging every 3 months and will have blood draws to look at every 1 month. After 6 months, they will have imaging and every 3 months for a year. They may receive additional imaging and blood draws if requested by their doctor.
Massachusetts General Hospital
Contact: Aparna Parikh, MD [email protected]
Dana Farber Cancer Institute
Contact: Marios Giannakis, MD [email protected]
- 18 years or older with 3 colon cancer that has been completely removed by surgery.
- have received standard chemotherapy after their colon cancer was surgically removed.
- have a life expectancy greater than 3 months.
- have normal organ function.
- are not pregnant.
- are willing to use two forms of effective contraception.
The following people may not be eligible:
- are receiving an experimental treatment
- received chemotherapy (chemotherapy before surgery)
- have cancer, cancer that has spread to other parts of the body.
- are unable to get standard chemotherapy or .
- have had more than 3-6 months of standard chemotherapy or .
- have had anticancer treatment within 30 days before the start of the study.
- have another uncontrolled illness such as an infection or heart condition.
- have psychiatric or substance use disorders.
- have an additional cancer diagnosis that is progressing or requires treatment.