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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.
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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
968 analysed.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Recurrence-free survival at 3 years by ctDNA statusprimary | ctDNA-negative | 702 | 87 percent | - | <0.001 | link |
| ctDNA-positive | 266 | 49 percent |
Shares CIRCULATE-Japan (GALAXY / VEGA / ALTAIR), DYNAMIC, Signatera, CAPOX (capecitabine, oxaliplatin).
Shares DYNAMIC, Signatera, Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA).
Shares CIRCULATE-Japan (GALAXY / VEGA / ALTAIR), Signatera, Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA).
Shares CIRCULATE-Japan (GALAXY / VEGA / ALTAIR), DYNAMIC, Signatera, Minimal / molecular residual disease (MRD).
Shares DYNAMIC, Signatera, Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA).
Shares BESPOKE CRC, CIRCULATE-US, DYNAMIC, Signatera.
Shares Signatera, Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA), MRD / molecular residual disease testing.
Shares Colorectal cancer: the failed and stopped programmes, and why, CAPOX (capecitabine, oxaliplatin), Oxaliplatin, FOLFOX (5-FU, leucovorin, oxaliplatin).