Circulating tumor DNA (ctDNA) in adjuvant therapy of early stage colon cancer: current status and future perspectives

Acta Oncol. 2022 Apr;61(4):523-530. doi: 10.1080/0284186X.2022.2033831. Epub 2022 Feb 9.


Background: This article reviews the current knowledge on circulating tumor DNA (ctDNA) in early stage colon cancer and ongoing trials on ctDNA-guided treatment in the adjuvant setting.

Methods: A literature search of Pubmed was performed to identify studies on ctDNA in early stage colon cancer and neoadjuvant or adjuvant treatment. For ongoing trials, we searched and the Australian New Zealand Clinical Trials Registry (ANZCTR).

Results: Several studies show that ctDNA is a strong predictor for recurrence and survival after surgery and adjuvant chemotherapy. The specificity of this marker is extremely high, and the sensitivity is increasing with the development of technology. Recurrences can be detected very early and the analysis can potentially be used to guide neoadjuvant and adjuvant treatment. Ongoing and planned studies are now looking into escalation and de-escalation of therapy according to ctDNA-status after surgery.

Conclusion: Serial measurement of ctDNA shows great promise as a marker for both prognosis and response to treatment in early colon cancer. Future studies will show whether we can use this analysis for tailoring treatment for patients in the adjuvant and neoadjuvant setting. With improved technology, ctDNA has the potential of becoming a 'game-changer' in the treatment of early stage colon cancers.

Keywords: adjuvant; colon cancer; ctDNA; neoadjuvant; ongoing trials.

Publication types

  • Review

MeSH terms

  • Australia
  • Biomarkers, Tumor / genetics
  • Chemotherapy, Adjuvant
  • Circulating Tumor DNA* / genetics
  • Colonic Neoplasms* / drug therapy
  • Colonic Neoplasms* / genetics
  • Humans
  • Neoplasm Recurrence, Local / pathology


  • Biomarkers, Tumor
  • Circulating Tumor DNA