Blood Test Could Identify Colon Cancer Patients to Benefit from NSAIDs

Up to 40% of people with stage III disease experience recurrence, highlighting the need for better ways to tailor post-surgical treatment. Anti-inflammatory drugs have long been suspected to reduce recurrence risk, but benefits have been inconsistent across patients. New evidence shows that a simple blood test can identify those most likely to benefit from adding an anti-inflammatory drug to chemotherapy.

In the study by Alliance for Clinical Trials in Oncology (Chicago, IL, USA), researchers focused on circulating tumor DNA (ctDNA), tiny fragments of cancer-derived genetic material that can persist in the bloodstream after tumor removal. CtDNA is detected using a blood sample followed by gene sequencing, offering a minimally invasive way to assess residual disease after surgery.

Celecoxib, a prescription nonsteroidal anti-inflammatory drug (NSAID), was evaluated alongside standard chemotherapy. NSAIDs are known to reduce inflammation, which plays a role in cancer growth and progression. The challenge has been determining which patients are likely to benefit, as routine use exposes others to unnecessary medication without a clear advantage.

Researchers analyzed ctDNA samples from 940 participants enrolled in the CALGB (Alliance) 80702 trial, part of a larger cohort of more than 2,500 patients with stage III colorectal cancer. Of these, 173 patients tested ctDNA-positive after surgery, placing them at high risk of recurrence. In this group, adding celecoxib to chemotherapy nearly doubled three-year disease-free survival and significantly improved five-year overall survival compared with placebo.

Patients who were ctDNA-negative did not show a survival benefit from celecoxib, suggesting they could safely avoid additional treatment. The findings, published in JAMA Oncology, demonstrate that ctDNA status is a powerful biomarker for identifying patients most likely to benefit from anti-inflammatory therapy after surgery.

The results, published in JAMA Oncology, suggest that ctDNA testing could help personalize colon cancer treatment by guiding the selective use of NSAIDs alongside chemotherapy. This approach may improve outcomes for high-risk patients while sparing others unnecessary side effects. Researchers emphasize that further prospective studies are needed to confirm these findings and integrate ctDNA-guided therapy into routine clinical practice.

“We’ve known that NSAIDs may help prevent recurrence in some patients with colon cancer, but until now, we didn’t know how to identify them. Measuring circulating tumor DNA levels after surgery using this blood test has the potential to change that,” said lead study author George Q. Zhang, MD, MPH.

Related Links:
Alliance for Clinical Trials in Oncology