# Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer: 5-year outcomes of the randomized DYNAMIC trial

Source: https://onco.cc/key-papers/paper-dynamic-nat-med-2025-update/  
OnCo record `paper-dynamic-nat-med-2025-update` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Later report from the DYNAMIC trial registered as ACTRN12615000381583, in Nature Medicine (2025); its title describes an updated or longer-term analysis.

## Summary

Early data from the DYNAMIC study of circulating tumor DNA (ctDNA)-guided adjuvant chemotherapy (ACT) versus standard approach met its primary outcome demonstrating reduced ACT use without compromising 2-year recurrence-free survival (RFS) for stage II colon cancer. We report here other prespecified analyses of overall survival, ctDNA clearance and ctDNA level. At a median follow-up of 59.7 months, 5-year RFS was 88% and 87% with ctDNA-guided and standard management, respectively (difference 1.1%, 95% confidence interval -5.8% to 8.0%), and 5-year overall survival is similar (93.8% versus 93.3%, hazard ratio (HR) 1.05; P = 0.887). For treated ctDNA-positive patients, ctDNA clearance was observed at the end of ACT (EOT) in 35 out of 40 patients (87.5%). A higher than median postoperative tumor-derived mutant molecules per milliliter plasma was associated with worse 5-year RFS (HR 10.62; P = 0.005). For treated ctDNA-positive patients, post hoc analysis of ctDNA clearance at EOT assessed by a new assay that evaluated an average of 29 tumor-derived mutations per patient predicted for a favorable 5-year recurrence-free probability of 97% versus 0% for ctDNA persistence (P < 0.001). Mature DYNAMIC outcome data support a ctDNA-guided approach to ACT for stage II colon cancer, with potential to further risk stratify ctDNA-positive patients based on ctDNA burden and EOT results. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12615000381583.

Indexed on Europe PMC as PubMed record 40055522 (DOI 10.1038/s41591-025-03579-w). Its abstract cites the registry id ACTRN12615000381583, which is how it was matched to this trial; no figure has been checked by an editor.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Tags: europepmc-ingest
- Journal: Nature Medicine
- Year: 2025
- DOI: 10.1038/s41591-025-03579-w
- Authors: Tie J, Wang Y, Lo SN, et al.
- What it means: A second publication from the DYNAMIC trial, later than the first and described in its title as an update or longer-term analysis. Read it with the primary publication linked from the trial page; the record was linked automatically and its figures have not been checked by hand.
- Caveats: Matched to the trial by the registry id cited in the Europe PMC record; the summary reproduces the record's abstract and no figure has been verified against the full paper.; Chosen as a later report by words in its title (updated, long-term, final, overall survival or a year count), not by reading the paper.

## Sources

- Nat Med 2025: https://doi.org/10.1038/s41591-025-03579-w
- PubMed: https://pubmed.ncbi.nlm.nih.gov/40055522/
- Europe PMC: https://europepmc.org/article/MED/40055522
- ClinicalTrials.gov ACTRN12615000381583: https://clinicaltrials.gov/study/ACTRN12615000381583

## Connected records

- trials: [DYNAMIC](https://onco.cc/trials/dynamic/)
- journals: [Nature Medicine](https://onco.cc/journals/nature-medicine/)

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