Systemic treatment post curative-intent intervention based on tumor-informed circulating tumor DNA result for oligometastatic colorectal cancer.

Authors

null

Teerada Siripoon

Ramathibodi Hospital, Mahidol University, Ratchathewi, Thailand

Teerada Siripoon , Conor O'Donnell , Nikolas Naleid , Patrick Starlinger , Thomas D. Atwell , Cornelius A Thiels , Susanne Warner , Jessica L. Mitchell , Krishan Jethwa , Christopher Leigh Hallemeier , Kellie Leanne Mathis , Sherief Shawki , Amit Mahipal , Zhaohui Jin

Organizations

Ramathibodi Hospital, Mahidol University, Ratchathewi, Thailand, Mayo Clinic School of Graduate Medical Education, Rochester, MN, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, Mayo Clinic, Rochester, MN, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, Division of Medical Oncology, Mayo Clinic, Rochester, MN

Research Funding

No funding sources reported

Background: Local therapies potentially offer a curative approach for patients with oligometastatic colorectal cancer (CRC). The effectiveness of systemic chemotherapy following definitive local treatment in this setting is not well-defined. Tumor-informed circulating tumor DNA (ctDNA) might guide management strategies after curative-intent local treatment. Methods: This is a single institution retrospective study of patients with CRC who underwent curative-intent local therapy to an isolated site of metastatic disease and had post-intervention tumor-informed ctDNA (Signatera) testing. The study was approved by the institutional review board. Clinical characteristics, including ctDNA results, were collected and evaluated. Kaplan-Meier method and log-rank test were used to calculate and compare disease-free survival (DFS). Factors associated with DFS were analyzed using multivariate Cox proportional hazards model. Results: 45 patients were included with median age of 59 years, 62% being male, 91% white, and 53% with stage IV disease at diagnosis. 37% of the patients had RAS mutations, no patient had BRAF mutation, and 2.2% patient had mismatch repair deficient disease. Isolated liver metastases were present in 80% of patients, lung metastases in 11% and other sites in 9%. 44 patients received chemotherapy prior to definitive treatment, with a median treatment duration of 16 weeks. ctDNA tests were done prior to local therapy in 23 patients, with 14 cases (61%) testing positive. Definitive treatment included resection (58%), ablation (13%), radiotherapy (4%), and multimodality (25%). Post-definitive treatment chemotherapy was administered to 24 (53%) patients. ctDNA positivity following definitive therapy was observed in 10 patients (22%), which was associated with a poorer prognosis, with a median DFS of 5.3 months compared to 21.3 months for the ctDNA-negative group (p<0.001). These findings were confirmed on multivariate analysis. In patients who had negative ctDNA after definitive local treatment, median DFS was 14.9 months for those who received post-intervention chemotherapy versus 21.3 months for those without post-intervention chemotherapy (p=0.835). Conclusions: Patients with negative ctDNA results following definitive local therapy for isolated metastatic CRC have better prognosis. Post-intervention chemotherapy in this group of patients was not associated with improved DFS. ctDNA guided omission of post-intervention chemotherapy following curative-intent local treatment of oligometastatic CRC warrants further study.

DFS in ctDNA negative patients after definitive treatment.

RecurrenceMedian DFS (months)P valueHazard ratio (univariate analysis)
No additional chemotherapy (N=16)8 (50%)21.3 (12.3-NR)
With additional chemotherapy (N=19)9 (47.4%)14.9 (8.4-NR)0.8351.11 (0.42-2.89)

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Abstract Details

Meeting

2024 ASCO Breakthrough

Session Type

Poster Session

Session Title

Poster Session A

Track

Gastrointestinal Cancer,Central Nervous System Tumors,Developmental Therapeutics,Genitourinary Cancer,Quality of Care,Healthcare Equity and Access to Care,Population Health,Viral-Mediated Malignancies

Sub Track

Real-World Evidence/Real-World Data

Citation

J Clin Oncol 42, 2024 (suppl 23; abstr 84)

DOI

10.1200/JCO.2024.42.23_suppl.84

Abstract #

84

Poster Bd #

F6

Abstract Disclosures