Postoperative circulating tumor DNA-based molecular residual disease in patients with BRAF V600E and MSI-H colorectal cancer: Updated results from GALAXY study in the CIRCULATE-Japan.

Authors

null

Jun Watanabe

Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan

Jun Watanabe , Eiji Oki , Daisuke Kotani , Yoshiaki Nakamura , Saori Mishima , Hideaki Bando , Hiroki Yukami , Koji Ando , Masaaki Miyo , Keiji Hirata , Naoya Akazawa , Kun-Huei Yeh , George Laliotis , Adham A Jurdi , Minetta Liu , Hiroya Taniguchi , Ichiro Takemasa , Takeshi Kato , Masaki Mori , Takayuki Yoshino

Organizations

Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan, Kyushu University, Fukuoka-Shi Higashi-Ku, Japan, National Cancer Center Hospital East, Japan, Kashiwa-Shi, Japan, Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan, National Cancer Center Hospital East, Kashiwa-Shi, Japan, Translational Research Support Section, National Cancer Center Hospital East, Kashiwa, Japan, Cancer Chemotherapy Center, Osaka Medical and Pharmaceutical University, Osaka, Japan, Department of Colorectal Surgery, National Cancer Center Hospital East,Kashiwa, Chiba, Japan, Chiba, Japan, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan, Department of Surgery 1, University of Occupational & Environmental Health, Fukuoka, Japan, Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, Sendai, Japan, National Taiwan University Hospital, Taipei, Taiwan, Natera, Inc, Austin, TX, Natera, Inc., Austin, TX, Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan, National Hospital Organization, Osaka National Hospital, Osaka, Japan, Tokai University, Hiratsuka, Japan, National Cancer Center Hospital East, Kashiwa, Japan

Research Funding

Other Government Agency
Japan Agency for Medical Research and Development (AMED), National Cancer Center

Background: Postoperative circulating tumor DNA (ctDNA)-based molecular residual disease (MRD) is reported to be associated with a high risk of recurrence. Here, we present an updated analysis of MRD detection and correlations with BRAF and MSI status in radically resected, stage II-IV colorectal cancer (CRC) from the observational GALAXY study (UMIN000039205). Methods: Serial ctDNA was analyzed using personalized tumor-informed assay (Signatera bespoke multiplex-PCR NGS assay) at 1 (4-week MRD time point), 3, 6, 9, 12, 18, and 24 months after surgery or until recurrence (whichever comes first). CT scans were conducted every 6 months. BRAF and MSI status were determined by central assessment until September 2021 and per the standard of care after October 2021. The primary endpoint was disease-free survival (DFS), defined as the time between the date of surgery and date of diagnosis with relapse or death due to any cause. Results: Among 3,615 CRC patients (pts) who were enrolled between May 2020 and April 2022 in GALAXY study, 2,083 pts that met the inclusion criteria were analyzed. The median follow-up period was 16.3 months. Of 2,083 pts included in the analysis, 60 pts (2.9%) had BRAF V600E mutant and MSS tumors, 100 pts (4.8%) had BRAF wt and MSI-H tumors, and 115 patients (5.5%) had BRAF V600E mutant and MSI-H tumors. In the overall population, 286 (14%) were ctDNA-positive at the 4-week MRD time point and 1,797 (86%) were ctDNA-negative. Pts with ctDNA-positivity at the 4-week demonstrated inferior DFS and were 12 times more likely to recur, compared to ctDNA-negative pts (HR: 12, 95%CI: 9.1-15%; p<0.001). Pts with BRAF wt and MSI-H tumors had significantly better DFS compared to pts with BRAF wt and MSS tumors (HR: 4.14, 95 %CI: 1.3-12.9, p=0.015). Pts with BRAF V600E mutant and MSI-H tumors had significantly better DFS compared to pts with BRAF wt and MSS tumors (HR: 4.80, 95 %CI: 1.5-15, p=0.007). On the other hand, ctDNA-positivity was associated with significantly shorter DFS in pts with BRAF V600E mutant and MSS tumors (HR: 2.33, 95%CI: 1.03-5.3, p=0.043) and BRAF V600E mutant and MSI-H tumors (HR:7.54, 95%CI:2.37-24, p<0.001) compared to pts with BRAF wt and MSS tumors. Multivariate analysis in DFS showed that ctDNA positivity was significantly associated with poor prognosis (HR: 11.68, 95%CI: 8.61-15.85, p<0.001), outperforming other clinicopathologic factors such as BRAF and MSI status. Conclusions: ctDNA status at the postoperative MRD time point is the most prognostic risk factor of DFS regardless of BRAF V600E or MSI-H status. Pts with positive postoperative ctDNA should be examined carefully due to a high risk of recurrence. ctDNA-guided adjuvant strategies will further be established by the ongoing randomized VEGA and ALTAIR studies in CIRCULATE-Japan. Clinical trial information: UMIN000039205.

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Abstract Details

Meeting

2023 ASCO Breakthrough

Session Type

Poster Session

Session Title

Poster Session B

Track

Gastrointestinal Cancer,Gynecologic Cancer,Head and Neck Cancer,Quality of Care,Genetics/Genomics/Multiomics,Healthcare Equity and Access to Care,Healthtech Innovations,Models of Care and Care Delivery,Population Health,Viral-Mediated Malignancies

Sub Track

Early Detection and Surveillance

Clinical Trial Registration Number

UMIN000039205

Citation

JCO Global Oncology 9, 2023 (suppl 1; abstr 32)

DOI

10.1200/GO.2023.9.Supplement_1.32

Abstract #

32

Poster Bd #

A4

Abstract Disclosures