Clinical Scorecard: The Fluid Future of Liquid Biopsy

At a Glance

Key Highlights

• Liquid biopsy can provide molecular information without repeated tumor-tissue sampling and supports serial assessment during treatment.
• Across studies presented at ASCO 2026, post-treatment ctDNA positivity was associated with worse disease-free survival or distant recurrence risk.
• In early triple-negative breast cancer, a study reported that ctDNA surveillance detected MRD before clinical or radiographic evidence of relapse.
• Researchers are evaluating mutation, methylation, and fragmentomic signals together to improve sensitivity and add biological context.
• Results described for daraxonrasib in previously treated metastatic pancreatic cancer showed activity in KRAS-mutant and non-mutant populations.

Guideline-Based Recommendations

Diagnosis

• The article describes liquid biopsy as complementary to tissue sampling and does not recommend replacing tissue testing.
• The article describes MRD approaches that identify tumor-specific mutations and search for them in circulating free DNA.

Management

• The article states that serial liquid-biopsy assessments may inform decisions about continuing or modifying treatment.
• The article reports prognostic and surveillance findings but does not establish a treatment algorithm based on ctDNA results.

Monitoring & Follow-up

• The article describes liquid biopsy as enabling longitudinal assessment of tumor evolution, treatment response, and recurrence risk.
• In a Phase 2 study of early triple-negative breast cancer, ctDNA surveillance detected MRD before clinical or radiographic evidence of relapse.

Risks

• The article identifies sensitivity in distinguishing rare tumor-derived DNA from normal circulating DNA as a challenge.
• The article raises questions about the added predictive value, complexity, cost, and laboratory consistency of multimodal testing.

Patient & Prescribing Data

The article discusses patients with cancer across tumor types, including patients after curative-intent treatment, patients with early triple-negative breast cancer, and patients with previously treated metastatic pancreatic cancer.

The article describes ctDNA as a potential source of prognostic and monitoring information. It reports daraxonrasib activity across KRAS-mutant and non-mutant populations in the RASolute 302 Phase III study; it provides no prescribing instructions or dosing information.

Clinical Best Practices

• The article frames liquid biopsy as complementary to tissue sampling, not as a universal replacement.
• The article reports prognostic associations and early MRD detection but does not specify a treatment response to a positive ctDNA result.
• The article describes mutation, methylation, and fragmentomic approaches as under evaluation and raises questions about predictive value, cost, and consistent laboratory implementation.

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