Tumors release tiny fragments of their DNA into the bloodstream. This so-called circulating tumor DNA (ctDNA) can be detected in the blood using modern molecular biological methods. The recently published CIRCULATE study is the first randomized trial to specifically investigate whether patients with detectable ctDNA benefit from chemotherapy.
Between 2020 and 2025, more than 2,100 patients in Germany and Austria were enrolled in the study. Patients with a positive ctDNA result were randomly assigned either to receive chemotherapy or to undergo the current standard treatment, namely observation only.
The results first confirmed the strong prognostic value of ctDNA: Three years after surgery, 87 percent of ctDNA-negative patients remained free of recurrence, compared with only 52 percent in the ctDNA-positive group.
Furthermore, the study demonstrated a concrete therapeutic effect for the first time in a randomized trial: Among the patients who actually received treatment, the three-year relapse-free survival rate was 77 percent with chemotherapy, compared with 38 percent without treatment. The risk of recurrence was therefore significantly reduced.
“This study provides two key findings,” explained study leader Prof. Gunnar Folprecht, an oncologist and senior physician at Medical Clinic I of Dresden University Hospital. “We were able to confirm that ctDNA is a clinically significant risk marker. More importantly, we demonstrated that patients who test positive for ctDNA actually benefit from chemotherapy.”
For clinical practice, this could mean that patients without detectable ctDNA can forgo chemotherapy, while those who test positive for ctDNA should receive more targeted treatment.
“A prerequisite for curing colon cancer is excellent surgery. To ensure long-term treatment success in patients with colon cancer, chemotherapy tailored to the individual risk of relapse after surgery is also significant,” emphasized Prof. Jürgen Weitz, co-author of the study, Director of the Department of Visceral, Thoracic and Vascular Surgery at the University Hospital Dresden, and one of the Managing Directors of the National Center for Tumor Diseases Dresden.
“The CIRCULATE study is an impressive example of how translational research transforms molecular insights into clinically useful evidence. Academic clinical trials are a central focus of Dresden University Medicine. CIRCULATE demonstrates the potential that translational oncology holds for the patient care of tomorrow,” said Prof. Esther Troost, Dean of the Faculty of Medicine at TUD Dresden University of Technology.
“For our patients, these results represent a real opportunity,” said Prof. Uwe Platzbecker, Medical Director of the University Hospital Dresden. “At UKD, we have the prerequisites to bring such innovative approaches into clinical practice through clinical trials once the framework conditions are clarified.”
However, there are still obstacles to the widespread use of this treatment approach. The test used in the study is not yet commercially available. Although commercial alternatives do exist, the costs are currently not routinely covered by statutory health insurance providers in Germany. “Before ctDNA-based treatment decisions can become part of everyday clinical practice, issues regarding availability and financing need to be resolved,” Folprecht summarized.
The CIRCULATE study was designed at Dresden University Hospital and funded by the Federal Ministry of Research, Technology and Space (BMFTR). Participants included the German Society for Medical Oncology (AIO), the Austrian Breast & Colorectal Cancer Study Group (ABCSG), Ruhr University Bochum, and more than 140 study centers in Germany and Austria.
“CIRCULATE — Chemotherapy for patients with circulating tumor DNA positive, stage II colon cancer”, DOI: 10.1016/j.annonc.2026.05.001: https://www.sciencedirect.com/science/article/pii/S092375342500064X
Prof. Gunnar Folprecht, Carl Gustav Carus University Hospital, TUD Dresden University of Technology
The CIRCULATE study is part of a rapidly evolving field of research. Together with findings from international studies — including the DYNAMIC study in Australia and the GALAXY study in Japan — the evidence is mounting that ctDNA testing could accurately personalize treatment planning for colon cancer in the future. The ongoing French CIRCULATE-PRODIGE-70 study is expected to provide additional data.
Prof. Gunnar Folprecht
Medical Clinic I
Carl Gustav Carus University Hospital, TUD Dresden University of Technology
Email: gunnar.folprecht@ukdd.de
Anne-Stephanie Vetter
Staff Unit Public Relations of the Carl Gustav Carus Faculty of Medicine of TUD Dresden University of Technology
National Center for Tumor Diseases (NCT/UCC) Dresden
Tel.: +49 351 458 17903
Email: anne-stephanie.vetter@tu-dresden.de
The National Center for Tumor Diseases (NCT/UCC) Dresden is a joint institution involving the German Cancer Research Center (DKFZ), the Faculty of Medicine at TU Dresden, the Carl Gustav Carus University Hospital Dresden and the Helmholtz-Zentrum Dresden-Rossendorf (HZDR). The NCT Dresden is part of NCT, which has further sites in Berlin, Heidelberg, SouthWest (Tübingen-Stuttgart/Ulm), WERA (Würzburg, Erlangen, Regensburg, Augsburg) and West (Essen/Cologne).
The NCT is committed to rapidly and effectively integrating innovations in cancer research into clinical trials in order to successfully diagnose and treat cancer according to the latest research. Patients are research partners on an equal footing.
The Dresden center draws on the structures of the University Cancer Center Dresden (UCC), which was founded in 2003 as one of the first Comprehensive Cancer Centers (CCC) in Germany. Since 2007, the Dresden center has repeatedly been awarded the title of “Oncological Center of Excellence” by the German Cancer Aid (DKH).
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