Post-resection ctDNA-MRD positivity in stage II/III colorectal cancer identifies patients...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`BMA-CTDNA-MRD-POST-TREATMENT-CRC`
Type	Actionability
Status	reviewed 2026-05-18 \| actionability review required
Diseases	`DIS-CRC`
Sources	`SRC-CIVIC` `SRC-ESMO-CRC-2024` `SRC-NCCN-COLON-2025`

Actionability Facts

Biomarker	`BIO-CTDNA-MRD-POST-TREATMENT`
Variant	ctDNA minimal residual disease — post-resection / post-adjuvant CRC
Disease	`DIS-CRC`
ESCAT tier	IIIA
Evidence summary	Post-resection ctDNA-MRD positivity in stage II/III colorectal cancer identifies patients at very high recurrence risk (DYNAMIC trial — Tie 2022; GALAXY/CIRCULATE-Japan — Kotani 2023). Persistently negative ctDNA in stage II low-risk patients allowed adjuvant-chemotherapy de-escalation in DYNAMIC without an OS detriment. ctDNA-MRD-guided escalation (post-positive intensification) is being tested prospectively (BESPOKE, COBRA, CIRCULATE-US, ALTAIR). NCCN Colon 2025 acknowledges ctDNA-MRD as emerging/optional; not yet a category-1 trigger. ESCAT IIIA — evidence base substantial but not yet level-A actionability.

Notes

STUB pending two-Co-Lead signoff. No post-treatment CRC surveillance Indication entity exists yet that ingests ctDNA-MRD status as a trigger (closest: future IND-CRC-POST-RESECTION-CTDNA-MRD-MONITORING). Until authored, indications: [] is intentional. Clinical use today: post-curative-resection serial draws at landmark (week 4-6) + every 3-6 months for 2-3 years. MRD-positive → multidisciplinary imaging re-evaluation; MRD-negative low-risk stage II → eligibility for chemo de-escalation per DYNAMIC paradigm (still trial-protocoled in most institutions). Engine must not auto-recommend adjuvant chemotherapy on ctDNA-MRD alone outside trial context — CHARTER §8.3.

Used By

No reverse references found in the YAML corpus.