Circulating Tumour DNA as Resistance Biomarkers: Real-Time Monitoring of Therapeutic Response.
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Abstract
Circulating tumour DNA (ctDNA) is a promising minimally invasive biomarker that reflects the genetic makeup and dynamic changes of tumours, with utility in monitoring treatment response and the emergence of drug resistance in patients with cancer. “biomarker of resistance” and “real-time monitoring of treatment response”. We aimed to review and collate the current evidence regarding the use of ctDNA as resistance biomarkers and its potential for use in real-time monitoring of treatment response. We performed a systematic review following PRISMA protocol. We searched electronic databases, including PubMed, Scopus, and Web of Science and Cochrane Library for studies published from January 2014 to December 2025. We included studies that used ctDNA to measure resistance mutations, monitor treatment response, and use dosing or treatment choices in treatment. We screened 1,421 records and included 40 studies. The patient ctDNA analysis enables early detection of resistance-associated mutations in often preceding radiologic progression. High sensitivity of ctDNA in evaluating the volume of tumour on-monitor as well as in identifying minimal residual disease. Use of ctDNA profiling improves the ability to modify treatment algorithms in real time and improves patient stratification.