{"entity":{"id":"dynamic-iii","kind":"trial","name":"DYNAMIC-III","aka":[],"tldr":"The sequel to DYNAMIC asked whether a blood test should also decide chemotherapy in stage III disease. It could not prove that less is safe, and more did not help.","summary":"DYNAMIC-III randomised patients with stage III colon cancer 1:1 to ctDNA-guided or standard management after testing at five to six weeks. Of 968 evaluable patients, 702 (72.5 percent) were ctDNA-negative. At a median 47 months, ctDNA-negative patients recurred far less often than ctDNA-positive ones (three-year recurrence-free survival 87 against 49 percent, p<0.001), confirming the prognostic power of the test. But de-escalation in ctDNA-negative patients, while reducing oxaliplatin use from 88.6 to 34.8 percent and hospitalisations from 13.2 to 8.5 percent, gave slightly lower recurrence-free survival and did not meet non-inferiority; escalation in ctDNA-positive patients gave no benefit. With ALTAIR also negative, the position at September 2026 is that ctDNA tells you who will relapse and, outside stage II disease, does not yet tell you what to do about it.","status":"mixed","asOf":"2026-09-24","links":[{"label":"DYNAMIC-III: circulating tumour DNA-guided adjuvant therapy in locally advanced colon cancer (Nature Medicine 2025)","url":"https://doi.org/10.1038/s41591-025-04030-w"},{"label":"ANZCTR ACTRN12617001566325","url":"https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374135"}],"tags":[],"related":[],"cancers":["colorectal","colon-cancer"],"sections":[],"technologies":["mrd-testing","liquid-biopsy"],"targets":[],"drugs":["signatera","folfox","capox","oxaliplatin"],"companies":["agitg"],"institutions":[],"pathways":[],"terms":["mrd","ctdna","de-escalation"],"trials":["dynamic","altair","circulate-us"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"ACTRN12617001566325","phase":"2/3","setting":"Stage III colon cancer: ctDNA tested 5 to 6 weeks after surgery, then de-escalated adjuvant therapy if negative and escalated if positive, against standard management","sponsor":"Walter and Eliza Hall Institute / Australasian Gastro-Intestinal Trials Group","result":"ctDNA is strongly prognostic (three-year recurrence-free survival 87 against 49 percent) but de-escalation was not non-inferior and escalation did not help.","yearReported":2025,"enrolled":968,"enrolledBasis":"analysed","enrolledNote":"968 evaluable patients; the trial is registered on the Australian New Zealand Clinical Trials Registry as ACTRN12617001566325 and has no NCT number.","outcomes":[{"endpoint":"Recurrence-free survival at 3 years by ctDNA status","primary":true,"unit":"percent","arms":[{"name":"ctDNA-negative","n":702,"value":87},{"name":"ctDNA-positive","n":266,"value":49}],"p":"<0.001","source":"https://doi.org/10.1038/s41591-025-04030-w"}],"replication":"DYNAMIC established de-escalation in stage II; DYNAMIC-III shows it does not carry over to stage III."},"route":"/trials/dynamic-iii/","neighbours":{"cancer":[{"id":"colon-cancer","kind":"cancer","name":"Colon cancer (adenocarcinoma of the colon)","route":"/cancers/colon-cancer/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"technology":[{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"drug":[{"id":"capox","kind":"drug","name":"CAPOX (capecitabine, oxaliplatin)","route":"/drugs/capox/"},{"id":"folfox","kind":"drug","name":"FOLFOX (5-FU, leucovorin, oxaliplatin)","route":"/drugs/folfox/"},{"id":"oxaliplatin","kind":"drug","name":"Oxaliplatin","route":"/drugs/oxaliplatin/"},{"id":"signatera","kind":"drug","name":"Signatera","route":"/drugs/signatera/"}],"company":[{"id":"agitg","kind":"company","name":"Australasian Gastro-Intestinal Trials Group","route":"/companies/agitg/"}],"term":[{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"colorectal-failed-programmes","kind":"term","name":"Colorectal cancer: the failed and stopped programmes, and why","route":"/terms/colorectal-failed-programmes/"},{"id":"de-escalation","kind":"term","name":"De-escalation, escalation and response-adapted therapy","route":"/terms/de-escalation/"},{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"}],"trial":[{"id":"altair","kind":"trial","name":"ALTAIR","route":"/trials/altair/"},{"id":"bespoke-crc","kind":"trial","name":"BESPOKE CRC","route":"/trials/bespoke-crc/"},{"id":"circulate-japan","kind":"trial","name":"CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)","route":"/trials/circulate-japan/"},{"id":"circulate-us","kind":"trial","name":"CIRCULATE-US","route":"/trials/circulate-us/"},{"id":"dynamic","kind":"trial","name":"DYNAMIC","route":"/trials/dynamic/"},{"id":"tracc","kind":"trial","name":"TRACC","route":"/trials/tracc/"}]}}