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.

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Declaration of Interests PG has received consulting fees from Haystack Oncology and honoraria from Amgen, Roche, Servier, Merck, Pierre-Fabre, and MSD. JT has received consulting fees from Haystack Oncology and Seres Therapeutics, honoraria from Astra Zeneca, Amgen, and Servier, support for attending meetings from Roche, participated on advisory boards for Beigene, Novartis, Astra Zeneca, Merck, Serono, MSD, Pierre Fabre, BMS, Daichii Sankyo, Takeda, Illumina, and Gilead, and has a leadership role on AGITG and ESMO. All other authors declare no competing interests.