Published: 30 March 2023
An innovative trial funded by NIHR and the Medical Research Council, which looks closely at colorectal cancer treatment, has opened.
The TRACC* Part C trial is being carried out at The Royal Marsden NHS Foundation Trust. It aims to find out if patients with the disease can be spared unnecessary chemotherapy. The study looks at the use of circulating tumour DNA (ctDNA) to guide chemotherapy decisions after surgery. It focuses on patients with resected early-stage colorectal cancer.
The test can detect microscopic molecular disease. It does this by measuring DNA shed from tumour cells into the bloodstream. If no ctDNA is found in a blood test following surgery, the patient’s treatment is de-escalated.
Many patients with high-risk stage II and stage III colorectal cancer have chemotherapy after surgery. It is offered routinely and recommended to help reduce the risk of relapse. It works by killing any microscopic cancer cells left after surgery. Without treatment, the cancer will return, usually within 2 years.
However, around 50% of patients are cured with surgery alone. Many may be overtreated as doctors have not been able to clearly advise them whether the treatment will be beneficial. Chemotherapy can sometimes be debilitating and cause lifelong side effects.
Findings from the TRACC Part B Study, which also received NIHR funding, support this. It shows patients with a negative ctDNA test after surgery are less likely to see their cancer return inside 2 years. This allows patients at low risk of recurrence to be identified. Their treatment may then be de-escalated. Instead, they may receive chemotherapy in tablet form, which has fewer side effects. In some cases, they may need no chemotherapy at all.
Professor David Cunningham, Director of Clinical Research at The Royal Marsden NHS Foundation Trust and Chief Investigator for the TRACC Part C study, said: “The results of this trial could help us tailor treatment decisions to benefit patients and reduce the side effects of chemotherapy, which will enable patients to have a better quality of life. There is also potential to realise significant cost savings for the NHS.”
*TRACC = Tracking mutations in cell free DNA to predict Relapse in eArly Colorectal Cancer.
TRACC Part C is funded by the Efficacy and Mechanism Evaluation (EME) Programme. EME is an NIHR and Medical Research Council (MRC) partnership.
TRACC Part B is funded by the NIHR Biomedical Research Centre at The Royal Marsden NHS Foundation Trust. Other funders include the Institute of Cancer Research, London and The Royal Marsden Cancer Charity.
For more information on the TRACC study, please visit the NIHR website.