Post-adjuvant chemotherapy in ctDNA-positive patients with resected colorectal cancer: a randomized phase 3 trial - Report - MDSpire

Post-adjuvant chemotherapy in ctDNA-positive patients with resected colorectal cancer: a randomized phase 3 trial

  • By

  • Hideaki Bando

  • Jun Watanabe

  • Yusuke Takahashi

  • Masahito Kotaka

  • Nobuhisa Matsuhashi

  • Eiji Oki

  • Yoshito Komatsu

  • Manabu Shiozawa

  • Keiji Hirata

  • Yuji Miyamoto

  • Masanobu Takahashi

  • Kentaro Yamazaki

  • Dai Manaka

  • Akiyoshi Kanazawa

  • Yi-Hsin Liang

  • Kun-Huei Yeh

  • Yuko Watsuji

  • Yuko Yamamoto

  • Makoto Fukui

  • Shruti Sharma

  • Vasily N. Aushev

  • Adham Jurdi

  • Matthew Rabinowitz

  • Minetta C. Liu

  • Alexey Aleshin

  • Ichiro Takemasa

  • Daisuke Kotani

  • Akihiro Sato

  • Toshihiro Misumi

  • Yoshiaki Nakamura

  • Qian Shi

  • Hiroya Taniguchi

  • Takayuki Yoshino

  • Takeshi Kato

  • June 8, 2026

  • 0 min

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Clinical Report: Adjuvant Chemotherapy Following Resection in ctDNA-Positive CRC Patients

Overview

The ALTAIR trial evaluates the efficacy of FTD/TPI in ctDNA-positive colorectal cancer patients post-resection. This phase 3 study aims to determine if FTD/TPI can improve outcomes compared to placebo in patients with no recurrence on imaging after standard adjuvant treatment.

Background

Colorectal cancer (CRC) remains a significant cause of cancer-related mortality, with a notable percentage of patients experiencing disease recurrence post-surgery. ctDNA has emerged as a promising biomarker for monitoring minimal residual disease (MRD) and guiding treatment decisions, although its clinical utility in adjuvant therapy remains under investigation.

Data Highlights

No numerical data provided in the source material.

Key Findings

  • Approximately 20% of stage I–III CRC patients experience disease recurrence post-surgery.
  • ctDNA positivity post-surgery is associated with increased recurrence risk and shorter disease-free survival (DFS) and overall survival (OS).
  • The DYNAMIC-II trial showed non-inferior recurrence-free survival with reduced chemotherapy in ctDNA-guided treatment for stage II colon cancer.
  • The DYNAMIC-III trial did not demonstrate improved outcomes with ctDNA-guided treatment escalation for stage III colon cancer.
  • The ALTAIR trial aims to evaluate FTD/TPI in ctDNA-positive patients after standard care.

Clinical Implications

The findings from the ALTAIR trial may provide insights into the role of ctDNA in guiding adjuvant therapy decisions. Understanding the efficacy of FTD/TPI in this patient population could inform future treatment protocols.

Conclusion

The ALTAIR trial represents a critical step in exploring ctDNA-guided treatment strategies in colorectal cancer, potentially impacting future adjuvant therapy approaches.

Related Resources & Content

  1. NCCN Updates ctDNA Stance in Colon, Rectal, and MCC Guidelines, OncLive, 2025 -- ctDNA as a prognostic biomarker
  2. Circulating tumor DNA-guided adjuvant therapy in locally advanced colon cancer: the randomized phase 2/3 DYNAMIC-III trial, Nature Medicine, 2025 -- ctDNA-guided management
  3. conexiant — Neoadjuvant Chemo Did Not Improve Disease-Free Survival
  4. The ASCO Post — Addition of Primary Tumor Resection to Chemotherapy for Asymptomatic Primary Colorectal Cancer Tumors and Synchronous Unresectable Metastases KEY POINTS
  5. the asco post — Adjuvant Chemoimmunotherapy for Resected Stage IB–IIIA NSCLC
  6. the asco post — ctDNA and Immunoscore in Resected Stage III Colon Cancer
  7. Neoadjuvant Chemo Did Not Improve Disease-Free Survival
  8. Addition of Primary Tumor Resection to Chemotherapy for Asymptomatic Primary Colorectal Cancer Tumors and Synchronous Unresectable Metastases
  9. NCCN Updates ctDNA Stance in Colon, Rectal, and MCC Guidelines | OncLive
  10. Circulating tumor DNA-guided adjuvant therapy in locally advanced colon cancer: the randomized phase 2/3 DYNAMIC-III trial | Nature Medicine
  11. Tissue-Free Circulating Tumor DNA Assay and Patient Outcome in a Phase III Trial of FOLFOX-Based Adjuvant Chemotherapy (Alliance N0147) - PubMed

Original Source(s)

Post-adjuvant chemotherapy in ctDNA-positive patients with resected colorectal cancer: a randomized phase 3 trial

  • by Hideaki Bando, Jun Watanabe, Yusuke Takahashi, Masahito Kotaka, Nobuhisa Matsuhashi, Eiji Oki, Yoshito Komatsu, Manabu Shiozawa, Keiji Hirata, Yuji Miyamoto, Masanobu Takahashi, Kentaro Yamazaki, Dai Manaka, Akiyoshi Kanazawa, Yi-Hsin Liang, Kun-Huei Yeh, Yuko Watsuji, Yuko Yamamoto, Makoto Fukui, Shruti Sharma, Vasily N. Aushev, Adham Jurdi, Matthew Rabinowitz, Minetta C. Liu, Alexey Aleshin, Ichiro Takemasa, Daisuke Kotani, Akihiro Sato, Toshihiro Misumi, Yoshiaki Nakamura, Qian Shi, Hiroya Taniguchi, Takayuki Yoshino, Takeshi Kato

  • June 8, 2026

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