Cancer Genetics and Epigenetics, 2025, Vol.13, No.6, 287-299 http://medscipublisher.com/index.php/cge 293 Figure 2 ctDNA-based treatment response monitoring is possible in postsurgical patients with CRC (Adopted from Kotani et al., 2023) For colorectal cancer patients with mismatch repair deficiency (dMMR) or high microsatellite instability (MSI-H), ctDNA monitoring has been used to guide the earlier application of immune checkpoint inhibitors (Burley et al., 2024). The WINDOW study found that in patients with locally advanced dMMR/MSI-H, scheduling immunotherapy in combination with ctDNA results helps protect organ function and increase the complete remission rate (Zhang et al., 2025). Overall, ctDNA, as a biomarker that can reflect disease changes in real time, not only helps to adjust the intensity of chemotherapy, but also enables high-risk patients to receive targeted or immunotherapy earlier (Kotani et al., 2023; Taieb et al., 2025; Tie et al., 2025). 5.3 Evidence support from clinical trials Multiple clinical trials have provided important evidence for the application of CTDNA-guided intervention in colorectal cancer. The DYNAMIC trial demonstrated that the use of ctDNA to guide adjuvant therapy for stage II colon cancer can reduce the use of chemotherapy while maintaining a recurrence-free survival rate similar to that
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