The ASCEND-CRC trial is part of an ADAPT program framework aimed at aligning cancer therapies with real-time tumor evolution in metastatic colorectal cancer. The initiative seeks to move beyond single pre-treatment biomarkers by employing multimodal profiling to longitudinally monitor tumor evolution and uncover early adaptive mechanisms that precede resistance. By identifying dynamic biomarkers that are actionable for treatment decisions, the study aims to guide therapeutic choices as tumors evolve rather than rely on static, baseline assessments. The overarching goal is to establish a scalable platform for intercepting resistance by integrating ongoing tumor profiling into clinical decision-making. Uncertainty remains regarding the specific biomarkers, methods, and interim outcomes to date, as the available description emphasizes objectives and conceptual approach rather than validated results. The ASCEND-CRC framework is presented as a component of broader ADAPT efforts intended to transform precision oncology and improve the ability to tailor therapies to evolving tumor biology.
Cancer evolution is a complex and dynamic process, yet most treatment strategies remain static. Infrequent tumor sampling has limited our ability to counteract the transient adaptive states that precede resistance. To address this gap, ARPA-H launched the ADAPT program, an initiative aimed at transforming cancer care by aligning therapies with real-time tumor evolution. Within this framework, the ASCEND-CRC trial aims to uncover early adaptive mechanisms and identify biomarkers to guide therapeutic decision-making in metastatic colorectal cancer (CRC). The study moves beyond single pre-treatment biomarkers by integrating multimodal profiling to longitudinally track tumor evolution and define an actionable set of dynamic biomarkers that inform treatment decisions. Together with other ADAPT initiatives, ASCEND-CRC represents a paradigm shift in precision oncology, establishing a scalable platform to intercept resistance.