Clinical application of circulating tumour DNA in colorectal cancer

Liquid biopsies that detect circulating tumour DNA (ctDNA) have the potential to revolutionise the personalised management of colorectal cancer. For patients with early-stage disease, emerging clinical applications include the assessment of molecular residual disease after surgery, the monitoring of adjuvant chemotherapy efficacy, and early detection of recurrence during surveillance. In the advanced disease setting, data highlight the potential of ctDNA levels as a prognostic marker and as an early indicator of treatment response. ctDNA assessment can complement standard tissue-based testing for molecular characterisation, with the added ability to monitor emerging mutations under the selective pressure of targeted therapy. Here we provide an overview of the evidence supporting the use of ctDNA in colorectal cancer, the studies underway to address some of the outstanding questions, and the barriers to widespread clinical uptake.

Automated summary

Liquid biopsies that detect circulating tumor DNA (ctDNA) have the potential to revolutionize personalized management of colorectal cancer. ctDNA assessment can complement tissue-based testing for molecular characterization and monitor emerging mutations under the pressure of targeted therapy. This article provides an overview of the evidence supporting the use of ctDNA in colorectal cancer, ongoing studies to address outstanding questions, and barriers to widespread clinical uptake.