The routine use of ctDNA as a basis for decision-making

The gap

Evidence profile

Sourced from the future work and limitations section of the source papers, classified as general, spanning 3 journals.

Supporting evidence — 3 representative gaps

• Resect first in resectable colorectal liver metastases: recalibrating the default (2026) · Annals of Hepato-Biliary-Pancreatic Surgery · doi

  ctDNA is emerging as a prognostic and potentially predictive biomarker in CRLM. Multiple studies have demonstrated that ctDNA positivity following curative resection is associated with early recurrence and inferior survival, while ctDNA negativity identifies patients with more indolent disease biology [33,34]. Prospective trials [35,36] are now exploring the role of ctD- NA-guided adjuvant therapy. In practical terms, ctDNA offers a route beyond broad clinicopathologic surrogates toward molecular residual disease stratification. This would involve enriching postoperative systemic therapy for patients with persistent ctDNA positivity while identifying lower-risk patients in whom treatment could potentially be de-escalated or withheld. Therefore, ctDNA may help define which patients are most likely to benefit from perioperative chemotherapy. Integrating ctDNA with clinicopathologic and molecular risk factors may further refine individualized treatment sequencing in the future.

  generalfuture workevidence 5/5
  Keywords: treatment ctdna patients disease therapy resectable oncol cancer adjuvant molecular risk perioperative liver colorectal trial
• Liquid Biopsy for Molecular Residual Disease Detection and Postoperative Surveillance in Gastric Cancer: Current Evidence and Future Directions (2026) · International Journal of Molecular Sciences · doi

  The routine use of ctDNA as a basis for decision-making in treatment planning is still considered investigational, - Tumor-agnostic approaches require further validation in the postoperative setting, - The number of patient-specific variants incorporated into personalized panels varies among assays and studies, - Analytical assay performance under specific experimental conditions should not be interpreted as equivalent to clinical sensitivity in postoperative MRD detection

  generallimitations sectionevidence 5/5
  Keywords: routine use ctdna basis decision-making treatment planning still
• Beyond a negative trial: timing, molecular residual disease, and antibody biology in adjuvant immunotherapy for resected NSCLC (2026) · Frontiers in Oncology · doi

  cross-trial comparisons cannot establish either treatment timing or MRD status as a causal determinant of efficacy, - the wide confidence interval, limited number of events, and immature follow-up require caution in interpreting the results of NADIM-Adjuvant, - analytical and biological heterogeneity pose significant obstacles to the clinical utility of post-operative ctDNA measurements, - sensitivity is especially problematic in patients who have low-volume residual disease or tumors with minimal ctDNA shedding

  generallimitations sectionevidence 5/5
  Keywords: cross-trial comparisons cannot establish either treatment timing mrd

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