New Advances in Prognostic Assessment of Stage III Colon Cancer: A Dual Approach Combining Tumor and Tumor Microenvironment
Team 1 of SIRIC CARPEM, regrouping Professor Pierre Laurent-Puig and Professor Julien Taieb from the Institut du Cancer PARIS CARPEM and the Cordeliers Research Center, has recently published two major studies in the Journal of Clinical Oncology.
These studies, conducted in collaboration with the Fédération Francophone de Cancérologie Digestive (FFCD) and the Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR), provide new insights into the management strategy for stage III colon cancer. They introduce an innovative dual approach to prognostic evaluation by combining the analysis of circulating tumor DNA (ctDNA) and the assessment of the tumor microenvironment through transcriptomic signatures and Immunoscore®.
In the first study, based on the PRODIGE-GERCOR IDEA-France and HORG-IDEA-Greece trials, researchers demonstrated that the presence of circulating tumor DNA (ctDNA) after surgery is a major prognostic factor. With a median follow-up of 6.7 years, ctDNA-positive patients had a significantly higher risk of recurrence than ctDNA-negative patients (HR = 5.21 for time to recurrence).
Additionally, Immunoscore®, which assesses tumor immune infiltration, also showed prognostic value in ctDNA-negative patients. This suggests that combining these two markers could help personalize adjuvant treatment strategies. Read the article
The second study, based on the PETACC-8 and IDEA-France trials, explored the prognostic value of transcriptomic signatures related to the tumor microenvironment and cell cycle. Researchers developed a prognostic model based on four signatures: CXCL13 expression (a marker of B-lymphocyte infiltration), an Oncotype-like signature, and signatures assessing M2 macrophage and T-lymphocyte infiltration in the tumor. This model, validated in two independent cohorts, enables a more refined stratification of recurrence risk than currently used clinical and histological parameters.While this model enhances risk assessment, ctDNA remains the most powerful prognostic factor. Read the article
These studies represent a major step toward precision medicine in the management of colon cancer. They pave the way for clinical trials incorporating these biomarkers to tailor the duration and intensity of adjuvant chemotherapy based on each patient’s individual risk.
