Clinical impact of prospective circulating tumour DNA testing for minimal residual disease in colorectal cancer: the INTERCEPT programme experience
In brief
Repeated blood tests detected 80% of recurrences, versus 49% with one test
In this prospective observational study of stage II to IV colorectal cancer, repeated circulating tumor DNA testing detected recurrence with 79.9% sensitivity, compared with 48.5% for a single timepoint. A positive result often prompted more intensive imaging, but the study did not show that testing improves outcomes; trials must establish when and how it should guide care.
- Journal
- Gut (Q1)
- Published
- 1 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Giulia Maddalena, Kathryn Aziz, Ryan Sun, Timothy E Newhook, Kristin Alfaro, Andrew Bowling, et al.
- PMID
- 42823331
- DOI
- 10.1136/gutjnl-2026-339167
Why clinicians should know about it
- Picked for Gastrointestinal and Colorectal Surgery (paper of the day, 2 October 2026): Prospective ctDNA MRD study, informs colorectal cancer recurrence risk
Abstract
BACKGROUND: The impact of circulating tumour DNA (ctDNA) detection, which informs minimal residual disease (MRD) after curative treatment, remains debated especially for stage IV patients. OBJECTIVE: The study objectives were to evaluate the prognostic role of MRD and to estimate lead time (LT) at different timepoints when adopting longitudinal MRD testing. DESIGN: INTERCEPT, is a prospective, observational cohort study of stage II-IV patients with colorectal cancer receiving curative-intent treatment who are longitudinally monitored using tissue-informed MRD assays as part of routine clinical care. RESULTS: Study results confirm the prognostic value of MRD, also beyond 12 months from surgery, with higher recurrence incidence in MRD-positive stage II-III patients than in MRD-negative stage IV patients (p<0.0001). Adjuvant therapy in stage IV disease showed limited durable benefit in both MRD-positive and negative patients. Clinical management was associated with increased use of more intensive second-line imaging (MRI, positron emission tomography; p<0.0001) when ctDNA was detected. Concurrent macroscopic disease detection was observed in 26% of cases and when excluded, LT from MRD detection to radiographic recurrence varies during surveillance (p=0.007). Multitimepoint testing improves sensitivity for recurrence (79.9% vs 48.5%) and may enable earlier, potentially curative interventions. CONCLUSION: ctDNA testing provides a framework for risk stratification and defines temporal windows that may inform future interventional strategies. Prospective interventional studies are required to define clinical utility and optimal implementation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.