ctDNA Monitoring Enhances Curative Treatment in Nonmetastatic CRC Patients

Recent findings from the phase 3 FIND trial presented at the 2025 ESMO Gastrointestinal Cancers Congress demonstrate that circulating tumor DNA (ctDNA)-guided surveillance significantly improves the detection of recurrence and increases the likelihood of curative-intent treatment in patients with nonmetastatic colorectal cancer (CRC). The trial's results suggest that this innovative approach could transform postoperative monitoring and treatment strategies for CRC patients.

The study compared ctDNA-guided surveillance with standard surveillance methods in a cohort of 584 patients aged 18 and older who had undergone surgical resection of nonmetastatic CRC. In the ctDNA arm, which included 289 patients, recurrence was detected in 8.3% of cases, while in the control arm of 295 patients, the recurrence rate was 10.5%. This equates to a relative risk reduction of 21% for the ctDNA group, indicating a statistically significant advantage (P = .034, 95% CI, 1.060-4.780).

According to Dr. Junjie Peng, chief physician and professor at the Department of Colorectal Surgery at Fudan University Shanghai Cancer Center, "The FIND trial methodology demonstrates the feasibility of a ctDNA methylation assay with a clinically actionable turnaround time for reporting results to guide surveillance decisions in nonmetastatic CRC."

In addition to earlier detection, the data revealed that 50% of patients experiencing recurrence in the ctDNA arm received curative-intent treatment, compared to only 22.6% in the standard surveillance arm. This aligns with prior research indicating that timely intervention is crucial for improving outcomes in CRC, where approximately 20% of recurrence cases can be treated surgically with curative intent.

The FIND trial utilized an advanced methylation-specific assay capable of detecting ctDNA at very low allele fractions. Patients in the ctDNA group underwent testing before surgery and subsequently every three months for two years. If ctDNA was detected, follow-up imaging was conducted to ascertain the presence of metastases, leading to timely treatment decisions by a multidisciplinary team.

The implications of these findings extend beyond individual patient care and pose significant questions for healthcare systems globally. As stated by Dr. Chunming Ding, founder of Innovation Biomed and co-author of the study, "The integration of ctDNA monitoring into routine practice could optimize resource utilization in CRC surveillance and improve overall patient outcomes."

In the context of healthcare economics, the financial impact of adopting ctDNA-guided surveillance could be substantial. A report from the American Cancer Society (2022) indicated that CRC treatment costs can escalate significantly due to late-stage interventions. Therefore, earlier detection and treatment could not only save lives but also reduce the economic burden on healthcare systems.

The FIND trial's findings are particularly relevant as colorectal cancer remains a leading cause of cancer-related deaths worldwide, with an estimated 1.9 million new cases diagnosed in 2020, according to the World Health Organization (WHO). Furthermore, the potential for ctDNA monitoring to be applied universally in various healthcare settings offers a promise of improved equity in cancer care.

Looking ahead, the incorporation of ctDNA monitoring into clinical practice could herald a new era in personalized medicine for CRC patients. As researchers continue to explore the full potential of ctDNA in oncology, these findings underscore the need for ongoing support and investment in innovative cancer monitoring technologies. Future studies will be essential to validate these findings across diverse populations and healthcare systems, ensuring that all patients have access to the best possible care.

In conclusion, the evidence from the FIND trial signals a paradigm shift in the management of nonmetastatic colorectal cancer, suggesting that ctDNA-guided surveillance could significantly improve patient outcomes through earlier detection and increased access to curative treatment.