{"entity":{"id":"paper-esmo-ctdna-assay-recommendations-ann-oncol-2022","kind":"paper","name":"ESMO recommendations on the use of circulating tumour DNA assays for patients with cancer: a report from the ESMO Precision Medicine Working Group","aka":[],"tldr":"Europe's oncology society advised that blood tests for tumour DNA can guide targeted treatment in advanced cancer, that tissue is still preferred for many patients, and that residual disease tests after surgery were not yet ready for routine use.","summary":"An ESMO expert working group reviewed the analytical and clinical validity and utility of plasma circulating tumour DNA assays. For advanced cancer, validated and adequately sensitive assays have utility in identifying actionable mutations to direct targeted therapy and may be used routinely, provided their limitations are taken into account. Tissue remains the preferred test for many patients because plasma assays are limited in detecting fusions and copy number changes, but plasma may be used routinely when faster results matter or tissue biopsy is not possible. Reflex tumour testing should be considered after a non-informative plasma result because of false negatives.\n\nFor early-stage cancer, detection of molecular residual disease or molecular relapse has high evidence of clinical validity in anticipating relapse in many cancers, but cannot be recommended in routine practice because there was no evidence of clinical utility in directing treatment. Response monitoring by early changes in tumour DNA, monitoring for resistance mutations before progression and screening of people without symptoms were under research and not recommended for routine practice.","asOf":"2026-10-20","links":[{"label":"Pascual et al., Ann Oncol 2022","url":"https://doi.org/10.1016/j.annonc.2022.05.520"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/35809752/"}],"tags":["precision","guideline"],"related":[],"cancers":[],"sections":["diagnostics"],"technologies":["liquid-biopsy","mrd-testing","mced"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["ctdna","mrd"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["annals-of-oncology"],"dependsOn":[],"notes":[],"journal":"Annals of Oncology","year":2022,"doi":"10.1016/j.annonc.2022.05.520","pmid":"35809752","authors":"Pascual J, Attard G, Bidard FC, et al.","paperType":"guideline","findings":["Advanced cancer: validated plasma assays may be used routinely to find actionable mutations, with tissue still preferred for many patients.","Reflex tissue testing advised after a non-informative plasma result.","Residual disease testing after curative treatment: high clinical validity, not recommended routinely because clinical utility was unproven.","Screening people without symptoms: research only."],"whatItMeans":"It draws the line this whole area turns on: a test can predict relapse well and still not be shown to help, until a trial shows that acting on it changes outcomes. Since then IMvigor011 (2025) showed longer survival with atezolizumab given on a positive result in muscle-invasive bladder cancer; DYNAMIC (2022) had already shown that a negative result could safely spare chemotherapy in stage II colon cancer.","caveats":["Written before the 2025 IMvigor011 and DYNAMIC-III results.","European perspective; national reimbursement varies."],"changedPractice":true},"route":"/key-papers/paper-esmo-ctdna-assay-recommendations-ann-oncol-2022/","neighbours":{"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"}],"technology":[{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"},{"id":"mced","kind":"technology","name":"Multi-cancer early detection (MCED)","route":"/technologies/mced/"}],"term":[{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"}],"journal":[{"id":"annals-of-oncology","kind":"journal","name":"Annals of Oncology","route":"/journals/annals-of-oncology/"}]}}