Circulating tumour DNA (ctDNA) is a promising biomarker that may better identify stage II colon cancer (CC) patients who will benefit from adjuvant chemotherapy (AC) compared to standard clinicopathological parameters. The DYNAMIC study demonstrated that ctDNA-informed treatment decreased AC utilisation without compromising recurrence free survival, but medical oncologists’ willingness to utilise ctDNA results to inform AC decision is unknown. Medical oncologists from Australia, Canada and New Zealand were presented with clinical vignettes for stage II CC comprised of two variables with three levels each (age: ≤50, 52–69, ≥70 years; and clinicopathological risk of recurrence: low, intermediate, high) and were queried about ctDNA testing and treatment recommendations based on results. Sixty-four colorectal oncologists completed at least one vignette (all vignettes,n= 59). The majority of oncologist were Australian (70%; Canada:n= 13; New Zealand:n= 6) and had over 10 years of clinical experience (n= 41; 64%). The proportion of oncologists requesting ctDNA testing exceeded 80% for all vignettes, except for age ≥ 70 and low-risk disease (63%). Following a positive ctDNA result, the proportion of oncologists recommending AC (p< 0.01) and recommending oxaliplatin-based doublet (p< 0.01) increased in all vignettes. Following a negative result, the proportion recommending AC decreased in all intermediate and high-risk vignettes (p< 0.01).
循环肿瘤DNA（ctDNA）作为一种有前景的生物标志物，相较于传统的临床病理学参数，可能更有效地识别出能从辅助化疗中获益的II期结肠癌患者。DYNAMIC研究表明，基于ctDNA指导的治疗在降低辅助化疗使用率的同时，并未影响无复发生存率，但肿瘤内科医生是否愿意依据ctDNA结果来指导辅助化疗决策尚不明确。本研究向来自澳大利亚、加拿大和新西兰的肿瘤内科医生展示了包含两个变量（年龄：≤50岁、52-69岁、≥70岁；临床病理复发风险：低、中、高）的II期结肠癌临床情景案例，并询问他们基于ctDNA检测结果的治疗建议。64位结直肠肿瘤专家至少完成了一个情景案例（完成全部案例者n=59）。大多数专家来自澳大利亚（70%；加拿大：13人；新西兰：6人），且拥有超过10年临床经验（n=41；64%）。除年龄≥70岁且低风险病例（63%）外，所有情景案例中要求进行ctDNA检测的肿瘤医生比例均超过80%。当ctDNA检测结果为阳性时，所有情景案例中推荐辅助化疗（p<0.01）及推荐含奥沙利铂双药方案（p<0.01）的肿瘤医生比例均显著增加。当检测结果为阴性时，所有中高风险情景案例中推荐辅助化疗的比例均显著下降（p<0.01）。
肿瘤(癌症)患者之家