The value of cell-free DNA for molecular pathology

Abstract

Over the past decade, advances in molecular biology and genomics techniques have revolutionized the diagnosis and treatment of cancer. The technological advances in tissue profiling have also been applied to the study of cell-free nucleic acids, an area of increasing interest for molecular pathology. Cell-free nucleic acids are released from tumour cells into the surrounding body fluids and can be assayed non-invasively. The repertoire of genomic alterations in circulating tumour DNA (ctDNA) is reflective of both primary tumours and distant metastatic sites, and ctDNA can be sampled multiple times, thereby overcoming the limitations of the analysis of single biopsies. Furthermore, ctDNA can be sampled regularly to monitor response to treatment, to define the evolution of the tumour genome, and to assess the acquisition of resistance and minimal residual disease. Recently, clinical ctDNA assays have been approved for guidance of therapy, which is an exciting first step in translating cell-free nucleic acid research tests into clinical use for oncology. In this review, we discuss the advantages of cell-free nucleic acids as analytes in different body fluids, including blood plasma, urine, and cerebrospinal fluid, and their clinical applications in solid tumours and haematological malignancies. We will also discuss practical considerations for clinical deployment, such as preanalytical factors and regulatory requirements. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Keywords: DNA sequencing; PCR; cancer; cell-free nucleic acids; circulating tumour DNA; genomics; liquid biopsy; molecular pathology.

Figure 1.

Clinical applications of cfDNA during the treatment process. Serial monitoring of ctDNA in plasma allows non-invasive identification of clinically relevant genomic alterations at different stages: molecular stratifications at diagnosis, tracking tumour responses during treatment, and identifying genetic mechanisms of resistance at progression. Colours represent tumour subclones with different mutations, which release ctDNA at different frequencies, as depicted in the graph below.