{"entity":{"id":"idea-bio1-ctdna-clone-report","kind":"idea","name":"A clone report from blood at every treatment cycle","aka":[],"tldr":"Blood tests can already detect tumour DNA. Reporting which sub-populations of the tumour are growing or shrinking, cycle by cycle, would turn the test into an evolution monitor.","summary":"Phylogenetic ctDNA analysis, as developed in TRACERx, assigns plasma variants to tumour subclones and tracks their relative abundance. The proposal is a standardised clinical report in which each ctDNA draw lists clone fractions, emergent clones, and clone-specific drug sensitivities, rather than a flat list of variants and allele frequencies.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Tumour heterogeneity and clonal evolution): Gerlinger et al., Intratumor heterogeneity and branched evolution (NEJM 2012)","url":"https://doi.org/10.1056/NEJMoa1113205"}],"tags":[],"related":["idea-ctdna-switch-generalised"],"cancers":["nsclc"],"sections":[],"technologies":["liquid-biopsy","mrd-testing"],"targets":[],"drugs":["osimertinib"],"companies":[],"institutions":[],"pathways":[],"terms":["ctdna","vaf"],"trials":[],"people":[],"bottlenecks":["b-tumor-heterogeneity","b-resistance"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Clone-level ctDNA reporting detects the expansion of a resistant subclone a median of three or more months before radiographic progression and changes management in at least a fifth of patients on targeted therapy.","rationale":"Resistance is subclone expansion. Existing panels report VAFs without the phylogenetic context that distinguishes clonal shrinkage from branch escape. The maths exists; the reporting format does not.","test":"Retrospective analysis on serial plasma from a completed TKI trial to compute lead time; then a prospective single-arm study in EGFR or ALK lung cancer where clinicians receive clone reports and act on pre-specified rules.","maturity":"early-clinical","actor":"data","cost":"medium","horizonYears":3},"route":"/ideas/idea-bio1-ctdna-clone-report/","neighbours":{"idea":[{"id":"idea-ctdna-switch-generalised","kind":"idea","name":"Molecular-progression switching beyond ESR1","route":"/ideas/idea-ctdna-switch-generalised/"}],"cancer":[{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"technology":[{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"drug":[{"id":"osimertinib","kind":"drug","name":"Osimertinib","route":"/drugs/osimertinib/"}],"term":[{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"vaf","kind":"term","name":"Variant allele frequency (VAF)","route":"/terms/vaf/"}],"bottleneck":[{"id":"b-resistance","kind":"bottleneck","name":"Acquired resistance to every therapy","route":"/bottlenecks/b-resistance/"},{"id":"b-tumor-heterogeneity","kind":"bottleneck","name":"Tumour heterogeneity and clonal evolution","route":"/bottlenecks/b-tumor-heterogeneity/"}],"paper":[{"id":"paper-gerlinger-intratumour-heterogeneity-nejm-2012","kind":"paper","name":"Gerlinger: a single biopsy misses most of the mutations in a kidney tumour","route":"/key-papers/paper-gerlinger-intratumour-heterogeneity-nejm-2012/"}]}}