According to the FIND trial, the use of circulating tumor (ct)DNA methylation-guided surveillance significantly increased the proportion of patients receiving curative therapy among patients with non-metastatic colorectal cancer who underwent surgery.

These data were first presented by Junjie Peng, MD, Fudan University, Shanghai, China, at the 2025 European Society for Medical Oncology (ESMO) Gastrointestinal Cancers Annual Congress in Barcelona, Spain.

For patients who have received curative-intent surgery for non-metastatic colorectal cancer, the early detection of and timely therapeutic intervention for recurrence in critical. The use of ctDNA methylation analysis may allow for earlier detection of minimal residual disease, compared to standard imaging modalities.

The prospective, multicenter, randomized phase 3 FIND trial randomized 528 patients post-surgery to receive either ctDNA methylation monitoring (n = 363) or standard surveillance (n = 365). Within the experimental group, both ctDNA monitoring and standard imaging were conducted — detection of positive ctDNA triggered immediate CT imaging. Upon negative imaging, CT scans were performed bimonthly and ctDNA testing was done quarterly. Following 2 consecutive ctDNA-negative results, imaging was done at the standard frequency. The primary end point of this study was the proportion of recurrent patients who received curative-intent therapy within 2 years after surgery.

At a median follow-up duration of 12 months, there were 74 instances of protocol deviation in the ctDNA group and 70 instances in the standard group. According to both the intention-to-treat and per-protocol analyses, there was no significant differences in cumulative recurrence rates (intention-to-treat, P = .671; per-protocol, P = .738). However, study authors noted “ctDNA-guided surveillance significantly increased the proportion of recurrent patients receiving curative therapy compared to standard surveillance” (50.0% vs 22.6%; P = .034).

Study authors concluded “ctDNA methylation-guided postoperative surveillance significantly enhances the likelihood of curative-intent treatment” among patients with recurrent non-metastatic colorectal cancer, when compared to standard imaging surveillance.

Source:

Peng J, Ding C, Mo S, et al. Dynamic circulating tumor DNA methylation monitoring guiding postoperative surveillance in non-metastatic colorectal cancer: Interim analysis of FIND trial. Presented at 2025 ESMO GI Congress. July 2-5, 2025; Barcelona, Spain. Abstract: LBA1