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Circulating Tumor DNA in Colorectal Cancer: Insights From the SWOG 80702 and BESPOKE Studies

Video Series

BESPOKE: Study Design, Efficacy End Points and Methods

John Marshall, MD​, and Mark Lewis, MD​, discuss how circulating tumor DNA (ctDNA) testing in colorectal cancer offers promising clinical utility across the care continuum, from early detection to treatment monitoring, with trials like BESPOKE and SWOG 80702 demonstrating its potential to guide personalized therapy decisions, predict outcomes based on minimal residual disease status, complement traditional imaging in challenging cases, and transform patient care through a patient-centric approach that requires ongoing research to establish standardized protocols.

Panelists discuss how circulating tumor DNA (ctDNA) serves as a promising biomarker for early detection, treatment monitoring, and recurrence surveillance in patients with colorectal cancer (CRC).

The Role of ctDNA in CRC

Panelists discuss how the BESPOKE study’s innovative design, carefully selected efficacy end points, and rigorous methodological approach aim to evaluate personalized therapeutic interventions with unprecedented precision.

BESPOKE: Study Design, Efficacy End Points, and Methods

Panelists discuss how the BESPOKE trial enrolled a diverse cohort of patients with varying demographic profiles, disease stages, comorbidities, and treatment histories to ensure comprehensive representation for personalized medicine approaches.

Overview of BESPOKE Patient Characteristics

Panelists discuss how BESPOKE trial results demonstrate significantly improved disease-free survival rates in patients with negative circulating tumor DNA (ctDNA) status compared with those with detectable ctDNA, underscoring its potential as a powerful prognostic biomarker.

BESPOKE: Highlighting the Disease-Free Survival by ctDNA Status 

Panelists discuss how circulating tumor DNA (ctDNA) clearance rates during and after adjuvant chemotherapy (ACT) in the BESPOKE trial provide critical insights into treatment efficacy and may serve as an early predictor of long-term patient outcomes.

BESPOKE: ctDNA Clearance During and After ACT

Panelists discuss how minimal residual disease (MRD) status, as detected through circulating tumor DNA analysis, can guide personalized treatment decisions by identifying patients who may benefit from intensification of adjuvant therapy and those who could safely undergo de-escalation of treatment regimens.

Role of MRD Status in Treatment Intensification or De-Escalation of Adjuvant Therapy 

Panelists discuss how SWOG 80702, a large-scale randomized clinical trial, employed a robust factorial design with clearly defined efficacy end points, including disease-free and overall survival, while enrolling a diverse patient population with stage III colon cancer to evaluate optimal adjuvant therapy duration and the impact of celecoxib.

SWOG 80702: Overview of Study Design, Efficacy End Points, and Patient Characteristics

Panelists discuss how the efficacy data from SWOG 80702 demonstrated that shortened duration of adjuvant chemotherapy (3 months vs 6 months) yielded comparable survival outcomes while significantly reducing treatment-related toxicities, challenging previous standard-of-care approaches for patients with stage III colon cancer.

SWOG 80702: Impressions on the Efficacy Data

Panelists discuss how tumor-informed circulating tumor DNA (ctDNA) testing offers a personalized molecular surveillance strategy that can revolutionize colorectal cancer management through earlier detection of recurrence, real-time monitoring of treatment response, and potential for therapy de-escalation in patients with negative results.

Potential Role of Tumor-Informed ctDNA in CRC

Panelists discuss how adopting a patient-centric approach with comprehensive education about circulating tumor DNA (ctDNA) testing empowers patients with colorectal cancer (CRC) to make informed decisions about their surveillance strategy while advancing personalized care pathways for the future.

Importance of Patient-Centric Approach and Patient Education of ctDNA Testing in CRC and Looking Ahead

Panelists discuss how circulating tumor DNA (ctDNA) testing serves as a complementary tool to traditional imaging in challenging colorectal cancer cases, offering molecular-level insights that can detect disease recurrence earlier, resolve ambiguous radiographic findings, and inform treatment decisions when conventional assessment methods yield inconclusive results.

The Role of ctDNA Testing in Colorectal Cancer Management: Exploring Its Use Alongside Imaging in Challenging Cases

Panelists discuss how research on circulating tumor DNA (ctDNA) testing in colorectal cancer requires careful consideration of standardized collection protocols, analytical validation, clinical utility assessment, integration with existing biomarkers, and longitudinal monitoring to establish its role in personalized treatment decision-making.

Research Considerations for ctDNA Testing in Colorectal Cancer

Between The Lines

 is an engaging 30- to 45-minute open discussion showcasing insightful and impactful perspectives from academic and community oncologists on published, peer-reviewed content.

BESPOKE: Study Design, Efficacy End Points, and Methods

EP: 1.The Role of ctDNA in CRC

EP: 2.BESPOKE: Study Design, Efficacy End Points, and Methods

EP: 3.Overview of BESPOKE Patient Characteristics

EP: 4.BESPOKE: Highlighting the Disease-Free Survival by ctDNA Status

EP: 5.BESPOKE: ctDNA Clearance During and After ACT

EP: 6.Role of MRD Status in Treatment Intensification or De-Escalation of Adjuvant Therapy

EP: 7.SWOG 80702: Overview of Study Design, Efficacy End Points, and Patient Characteristics

EP: 8.SWOG 80702: Impressions on the Efficacy Data

EP: 9.Potential Role of Tumor-Informed ctDNA in CRC

EP: 10.Importance of Patient-Centric Approach and Patient Education of ctDNA Testing in CRC and Looking Ahead

EP: 11.The Role of ctDNA Testing in Colorectal Cancer Management: Exploring Its Use Alongside Imaging in Challenging Cases

EP: 12.Research Considerations for ctDNA Testing in Colorectal Cancer

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