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Clinical utility and future perspectives of liquid biopsy in colorectal cancer

Year: 2025

Type: article

Abstract: Colorectal cancer (CRC) management has transformed with the growing integration of liquid biopsy in everyday clinical practice. Liquid biopsy, a non-invasive technique that detects tumor DNA released into the bloodstream (ctDNA), offers a convenient method to characterize cancer via routine blood draws 1 . ctDNA shows potential for cancer detection, monitoring, and therapeutic decision-making 1 . Given the increasing popularity of ctDNA tests and availability of direct-to-consumer options, there are a variety of ctDNA-based tests that can be performed. Each test has its own pros and cons, and their broad adoption necessitates rigorous evidence to support reliability, validity, cost-effectiveness and, most importantly, clinical utility – confirming that ctDNA-guided management can improve patient outcomes compared to the status quo 2 . Currently, insurance coverage or reimbursement from national health systems of ctDNA-based liquid biopsies in CRC is limited, only provided in the US and Japan, despite recommendations from leading international oncology societies for specific indications 1 , 3 . This discrepancy, combined with the rapidly growing number of publications on ctDNA, might lead to conflicting opinions among healthcare providers, as well as patients, about how and when ctDNA tests should be utilized in clinical care. Therefore, it is critical to distinguish between ctDNA applications that are well-supported by evidence and could be safely and effectively implemented in our clinical practice by tomorrow, and those that are still tentative and need further validation. As physicians and scientists, it is our responsibility to guide patients through the complexities of emerging technologies. Here we discuss emerging clinical applications of ctDNA tests in three main areas of CRC management (metastatic CRC, locally advanced disease and early disease), with the aim to ensure that expectations are realistic and informed by both the latest scientific evidence and individual patient contexts (also refer to Fig. 1 ).

Source: Communications Medicine

DOI: 10.1038/s43856-025-00852-4