Assays built from sequencing of that patient’s tumor.
A JAMA Oncology analysis published online August 13, 2026, of 1,026 plasma samples from 159 patients in the c-TRAK TN surveillance cohort found that tissue-free ctDNA detection was associated with recurrence (HR 27.2; 95% CI 13.7 to 54.2), and median lead time to recurrence was 7.6 months with the tissue-free assay versus 7.1 months with a multivariant tumor-informed assay.
JAMA Oncology
A Cell paper published online November 7, 2025, applied a whole-genome tumor-informed ctDNA assay to 2,994 plasma samples from 431 patients with non-small cell lung cancer in TRACERx and reported that detection below 80 parts per million, before and after surgery, was prognostic, and that patients who cleared ctDNA during adjuvant therapy had better outcomes.
Cell
A Journal for ImmunoTherapy of Cancer analysis published July 11, 2025, of adjuvant nivolumab with or without ipilimumab in resected stage III or IV melanoma found tumor-informed ctDNA at baseline in 16.2% of tested patients, and ctDNA positivity at baseline or on treatment was associated with recurrence (HR 1.97; 95% CI 1.57 to 2.46).
Journal for ImmunoTherapy of Cancer
In the January 13, 2025 Nature Medicine TRACERx analysis, lung adenocarcinomas with preoperative ctDNA detected below 80 parts per million still had worse overall survival than ctDNA-negative adenocarcinomas (HR 12.33; 95% CI 1.63 to 93.35).
Nature Medicine
A Nature Medicine paper published January 13, 2025, tested preoperative plasma from 171 TRACERx patients and detected ctDNA in 76 of 94 lung adenocarcinomas (81%), including 16 of 28 with stage I adenocarcinoma, and in 77 of 77 non-adenocarcinoma non-small cell lung cancers.
Nature Medicine
In the phase 3 ALTAIR trial published in Nature Medicine on June 8, 2026, 243 patients with resected colorectal cancer who became tumor-informed ctDNA-positive without radiographic disease were randomized to trifluridine/tipiracil or placebo; median disease-free survival was 9.30 versus 5.55 months (HR 0.79; P = 0.107), so the primary endpoint was not met.
Nature Medicine
An ASCO 2026 retrospective cohort of 72 patients with high-grade epithelial ovarian cancer, 69 of whom were in clinical remission, found ctDNA positivity in 30 and second-look laparoscopy positivity in 33; on multivariable analysis ctDNA positivity predicted shorter progression-free survival (HR 4.35; 95% CI 2.17 to 8.72).
Journal of Clinical Oncology
In the NeoCircle analysis of 116 patients with stage I to III breast cancer presented at ASCO 2025, postoperative molecular residual disease detected with a tumor-informed structural-variant assay was associated with a shorter relapse-free interval (HR 45.5; 95% CI 13.0 to 159.8) and shorter overall survival (HR 15.3; 95% CI 4.5 to 52.9).
Journal of Clinical Oncology
An ASCO 2025 preliminary report from MONSTAR-SCREEN-3, with 114 patients across 15 cancer types as of December 2024, found baseline ctDNA in 41 of 41 tested patients and postoperative month-1 MRD positivity in 10 of 28, including colorectal, gastric, head and neck, renal cell, esophageal, and pancreatic cancers.
Journal of Clinical Oncology
The ASCO 2025 preliminary MONSTAR-SCREEN-3 report enrolled 22 patients with gastric cancer and 8 with esophageal cancer among 114 patients across 15 cancer types.
Journal of Clinical Oncology
In the final MRD analysis of the observational BESPOKE CRC study presented at ASCO GI 2025, ctDNA positivity in the postoperative window was associated with inferior disease-free survival in stage II disease (HR 10.4) and stage III disease (HR 10.1) among patients with a result in that window.
Journal of Clinical Oncology
In the observational alpha-CORRECT cohort of 124 patients with stage III colorectal cancer presented at ASCO GI 2025, a tumor-informed assay using up to 200 variants found that ctDNA positivity during surveillance was associated with recurrence (HR 49.6; 95% CI 16.6 to 148.3), with a median lead time of 10.4 months before a clinical diagnosis of recurrence.
Journal of Clinical Oncology
In the phase 3 ZEST trial, reported at SABCS 2024, enrollment stopped early after 1,901 patients had a tumor-informed ctDNA result and only 40 were randomized; of 147 patients with ctDNA detected, 72 (49%) already had radiographic recurrence on staging before randomization.
Clinical Cancer Research
The ESMO 2024 IMpower010 ctDNA update reported that chemotherapy converted 62% of patients who were ctDNA-positive after surgery to ctDNA-negative, and that this clearance was associated with longer disease-free survival.
Annals of Oncology
At ESMO 2024, an updated IMpower010 analysis of resected stage II to IIIA non-small cell lung cancer reported that postoperative ctDNA positivity was a negative prognostic factor for disease-free survival after at least 5 years of follow-up, and that disease-free survival was longer with atezolizumab than with best supportive care in both ctDNA-positive and ctDNA-negative groups.
Annals of Oncology