Dr. Cohen on the Clinical Implications of the GALAXY Trial in CRC

Stacey A. Cohen, MD, physician, Seattle Cancer Care Alliance, associate professor, Division of Medical Oncology, University of Washington (UW) School of Medicine, physician, UW Medicine, and associate professor, Clinical Research Division, Fred Hutchinson Cancer Research Center, discusses the clinical implications of the ongoing GALAXY trial (UMIN000039205), part of the CIRCULATE-Japan project, in colorectal cancer (CRC).

Early results from the study, which is monitoring ctDNA status in patients with stage II to stage IV CRC who are undergoing surgical resection, showed a minimal difference in disease-free survival (DFS) among patients who were preoperatively ctDNA negative vs positive, according to Cohen. Although ctDNA did not provide prognostic insight when examined in patients before surgery, those found to be ctDNA negative after surgery did have better outcomes, Cohen explains. As such, there is evidence to support that ctDNA status can provide insight into which patients are more likely to experience recurrence or worse outcomes, Cohen says. Still, how to optimally treat patients with CRC based on their ctDNA status remains unclear, Cohen notes.

The goal of treating, and hopefully curing, patients with CRC is to do so with minimal toxicity and intervention, Cohen adds. For example, some patients may only require surgery plus short-course chemotherapy, although others with more aggressive disease may require more intense treatment. As such, utilizing ctDNA can help to stratify those patients and determine a treatment strategy that is more tailored to their disease type, Cohen says.

Additionally, more research efforts are needed to ensure that the correct patient populations are being matched to the correct treatments, Cohen adds. As more data become available, it is evident that not all patients with CRC should be treated with the same approaches. Utilizing new prognostic markers can help to do this moving forward, Cohen concludes.