Detection of tumour‐specific circulating cell‐free DNA in plasma (ctDNA) fails in a significant number of cases depending on the clinical context. The primary aim was to investigate clinicopathological factors associated with detection of ctDNA in patients with RAS‐/BRAF‐mutated metastatic colorectal cancer (mCRC) prior to first‐line therapy. A secondary aim was to evaluate the prognostic impact of ctDNA compared to other biomarkers. Patients were included from the NORDIC‐VII study (N = 253). ctDNA was sampled prior to treatment and analysed for hotspot tissue mutations (KRAS, NRAS, and BRAF) using droplet digital PCR. Multivariable regression models were constructed to predict the probability of mutation detection and survival. Increasing radiological size of target lesions by increments of 1 cm (odds ratio [OR] = 1.18; 95% confidence interval [CI] 1.09‐1.27; P < .001), intact primary tumour (OR = 3.17; 95% CI 1.22‐8.22; P = .018) and more than one metastatic site (OR = 3.08; 95% CI 1.32‐7.19; P = .009) were associated with mutation detection in plasma. Metastatic involvement of the lung was associated with non‐detection (OR = 0.26; 95% CI 0.12‐0.58; P = .001). Preanalytical and analytical factors modulated detection. High allele frequencies of ctDNA indicated poor prognosis independently of CEA and CA19‐9 (hazard ratio [HR] = 2.38; 95% CI 1.74‐3.26; P < .001; N = 206). Clinicopathological characteristics should be carefully considered when evaluating ctDNA results from mCRC patients, especially when confronted with a plasma negative result. ctDNA may prove to be a clinically useful marker in the evaluation of mCRC treatment.

Background. Despite robust evidence from randomized controlled trials (RCTs) demonstrating clinical and patient-reported benefits of integrated oncology and palliative care, the tumour-centred focus is predominant. This single–centre process evaluation monitors documentation of required patient-centred variables during an RCT. Methods. Performance status, patient self-reported symptoms, weight and summaries to general practitioners were assessed from June 2017 to July 2020 in three consultation types: first oncological after study inclusion and palliative and oncological consultations during chemotherapy. Descriptive statistics were used to monitor if the pre-defined program fulfilment of ≥85% documentation was reached. Results. 435 consultations were monitored in 76 patients; 60.5% males, 86.8% with GI cancers; 76 (17.5%) were from the first oncological consultations, 87 (20.0%) and 272 (62.5%) from palliative or subsequent oncological consultations. Program fulfilment differed across consultation types with 94.8% in the palliative consultations (83.3–100%), relative to 65.8% (62.5–75.0%) and 69.2% (57.0–84.3%) for first and subsequent oncological consultations over time, respectively. Use of self-reported symptoms was consistently lower in the oncological consultations. Conclusions. The documentation level of required core variables was not satisfactory, notwithstanding their high clinical relevance and continuous reminders during study. Pre-trial optimization strategies are paramount to promote integration and reduce professional and personal barriers towards a more patient-centred focus.

Purpose: Local therapy (LT) for metastatic colorectal cancer (mCRC) is recommended when eradicating all metastases is feasible. Although LT is widely used, its population-level impact remains unclear. This study aims to use real-world population-based data to assess LT utilization and survival trends in mCRC. Methods: Patients diagnosed with mCRC from 2010 to 2023 were included, using data from the Cancer Registry of Norway and the Norwegian Patient Registry. LT was defined as surgery, stereotactic radiotherapy (SRT), or ablation targeting liver, lung, or brain metastases. Outcomes were reported as median overall survival (OS) and 2-, 5-, and 10-year OS. The effect of the first versus last time period on survival was assessed using univariable and multivariable Cox regression. Results: Among 64,112 CRC cases, 20,210 had mCRC. Of these, 21% received LT, 39% systemic therapy only, 12% other therapies, and 29% no therapy. Metastasectomy was the primary LT (87%), whereas SRT use was limited. LT use increased by 12% annually from 2010 to 2015 and then stabilized. The overall mCRC survival improved, with the 5-year OS increasing from 16% to 23% and the median OS from 15 to 18 months (adjusted hazard ratio, 0.92; 95% CI, 0.89 to 0.95). No significant survival improvement was observed between time periods in the LT or systemic therapy only subgroups. The 5-year OS for patients receiving LT for liver, lung, and brain metastases was 50%, 62%, and 5%, respectively. Conclusion: LT utilization increased, with outcomes comparable with more selected populations. Survival in treatment subgroups remained stable over time, but improved in the overall mCRC population, suggesting that the population-level gains may reflect changes in treatment allocation rather than improvements within modalities.