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This is the first prospective randomized trial demonstrating that ctDNA guided Adjuvant chemotherapy (ACT) improves time to recurrence (TTR) and Disease-free survival (DFS) in stage II colon cancer pts without clinical risk factors, pt with negative CtDNA had better overall survival (OS) and DFS than pts with positive CtDNA, Pts who with Positive CtDNA who and chemotherapy also had better DFS compared to the ones who underwent surveillance (77% vs 38%).

No oxaliplatinum in stage 2 colon cancer, even high-risk patients, by the way, De Gramont is one of the authors (father of FOLOFX reigmens).

There is more movement towards using time to relapse as an endpoint for adjuvant studies. This report highlights that there is still a role for oxaliplatin in older patients with Stage III CRC. The time to relapse was not significantly different in patients who are younger vs older. TTR is suggested as a more informative endpoint as older patients uniformly have a lower DFS and OS in most trials.

Epi and nivo for mismatch repair-deficient (dMMR) colon cancer had 98% response rate with 68% complete response, non-recurred with a median of follow up of 26 months. Does this mean bye-bye surgery??? Probably. We will need to assess those who have complete response and have a close follow up. CtDNA may play big role here, along with a need for randomized trials.

COLOXIS is an interesting computer-based learning model that seems to be able to predict which patients are likely to benefit from adjuvant chemotherapy in colorectal cancer. This, along with ctDNA tests, may change whom we choose to offer adjuvant chemotherapy.

Stopping oxaliplatinum and cont. of 5FU is better than stopping all chemotherapy. An option for patients with worsening neuropathy or other oxaliplatinum toxicity.

Get your patients moving, even in the adjuvant setting! Of course, a lot of bias is possible here, but there was nearly a 10% difference in cure at three years.