{"entity":{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","aka":["circulating tumor DNA","ctDNA-positive","ctDNA-negative","ctDNA-based","ctDNA-directed","tumour fraction"],"tldr":"Circulating tumour DNA (ctDNA) consists of fragments of DNA shed by tumour cells into the blood, detectable with sensitive sequencing.","summary":"Circulating tumour DNA (ctDNA) is made up of DNA fragments shed by tumour cells into the bloodstream, where they form only a small fraction of all cell-free DNA and are detected with sensitive sequencing. Its uses span genotyping for companion diagnostics, tracking resistance mutations such as EGFR T790M and ESR1, molecular residual disease, early detection and response monitoring. Shedding varies with tumour type and burden, and clonal haematopoiesis can confound results. The term underpins the Liquid biopsy (ctDNA), MRD / molecular residual disease testing and Multi-cancer early detection (MCED) technologies, and it appears in the SERENA-6, CIRCULATE-Japan and IMvigor011 trials and in ideas on molecular-progression switching beyond ESR1 and HPV ctDNA to guide cervical cancer therapy.","asOf":"2026-09-04","wikipedia":"https://en.wikipedia.org/wiki/Circulating_tumor_DNA","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Circulating_tumor_DNA"}],"tags":[],"related":[],"cancers":["nsclc","prostate","prostate-mcrpc"],"sections":[],"technologies":["liquid-biopsy","mrd-testing","mced"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-leighl-nile-cfdna-tissue-genotyping-ccr-2019","paper-aggarwal-plasma-genotyping-personalised-therapy-jama-oncol-2019","paper-oxnard-osimertinib-resistance-mechanisms-jama-oncol-2018","paper-lindeman-lung-molecular-testing-guideline-jto-2018","paper-wyatt-ctdna-tissue-concordance-mcrpc-jnci-2017","paper-tukachinsky-ctdna-3334-advanced-prostate-ccr-2021","paper-annala-ctdna-resistance-abiraterone-enzalutamide-cancer-discov-2018"],"journals":[],"dependsOn":[],"notes":["Lung cancer: plasma genotyping at diagnosis is non-inferior to tissue for finding a guideline biomarker (27.3% against 21.3% in 282 patients), has 100% positive predictive value for the alterations with approved drugs, returns in 9 days against 15, and raises detection by 48% when added to tissue (Leighl 2019). Clinical sensitivity against tissue is 80%, so a negative plasma result rules nothing out and the guideline permits plasma to rule in only (Lindeman 2018). Serial plasma after starting treatment also separates the patients whose resistant clone was already present, within three weeks (Oxnard 2018)."],"category":"Biomarkers"},"route":"/terms/ctdna/","neighbours":{"cancer":[{"id":"borderline-resectable-pdac","kind":"cancer","name":"Borderline resectable pancreatic ductal adenocarcinoma","route":"/cancers/borderline-resectable-pdac/"},{"id":"braf-v600e-colorectal","kind":"cancer","name":"BRAF V600E-mutant colorectal cancer","route":"/cancers/braf-v600e-colorectal/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"erdheim-chester-disease","kind":"cancer","name":"Erdheim-Chester disease","route":"/cancers/erdheim-chester-disease/"},{"id":"histiocytoses","kind":"cancer","name":"Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms","route":"/cancers/histiocytoses/"},{"id":"gallbladder","kind":"cancer","name":"Gallbladder 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carcinoma","route":"/cancers/nasopharyngeal/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"recurrent-metastatic-nasopharyngeal-carcinoma","kind":"cancer","name":"Recurrent and metastatic nasopharyngeal carcinoma","route":"/cancers/recurrent-metastatic-nasopharyngeal-carcinoma/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"},{"id":"resectable-nsclc","kind":"cancer","name":"Resectable stage I to III non-small-cell lung cancer","route":"/cancers/resectable-nsclc/"},{"id":"stage-ii-melanoma","kind":"cancer","name":"Stage IIB and IIC melanoma","route":"/cancers/stage-ii-melanoma/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"},{"id":"stage-iii-unresectable-nsclc","kind":"cancer","name":"Unresectable stage III non-small-cell lung cancer","route":"/cancers/stage-iii-unresectable-nsclc/"}],"technology":[{"id":"cea-surveillance-colorectal","kind":"technology","name":"CEA surveillance after colorectal cancer surgery","route":"/technologies/cea-surveillance-colorectal/"},{"id":"cellsearch-ctc-count","kind":"technology","name":"CellSearch circulating tumour cell count","route":"/technologies/cellsearch-ctc-count/"},{"id":"fragmentomics","kind":"technology","name":"cfDNA fragmentomics","route":"/technologies/fragmentomics/"},{"id":"cthpv-dna","kind":"technology","name":"Circulating tumour HPV DNA (ctHPV-DNA)","route":"/technologies/cthpv-dna/"},{"id":"continuous-ctdna-monitoring","kind":"technology","name":"Continuous and near-continuous ctDNA 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