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By building a family tree of each tumour's mutations first, the TRACERx team could find the cancer's DNA in blood after surgery and tell which patients would relapse, before any scan showed anything.
Abbosh, Birkbak, Wilson and colleagues, with Swanton as senior author, profiled circulating tumour DNA in the first 100 TRACERx participants using a tumour-specific phylogenetic approach, including one patient also recruited to the PEACE post-mortem study.
The method is the contribution. Rather than looking for a generic panel of mutations, the assay is built from the tumour's own phylogeny, which makes it sensitive enough to detect residual disease and specific enough to say which subclone is responsible for the relapse. It is the lung cancer arm of the minimal residual disease field that ctDNA-guided colorectal trials later industrialised.
The foundation of minimal residual disease testing in lung cancer: a blood test that says a patient will relapse months before a scan does, and says which part of the tumour is doing it. Whether acting on that signal changes outcome is what the ctDNA-guided trials are for.
Shares TRACERx first 100: tracking how lung cancers evolve, and how chromosomal chaos predicts relapse, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment, Tumour heterogeneity and clonal evolution and the tag lung-evidence.
Shares Charles Swanton, TRACERx first 100: tracking how lung cancers evolve, and how chromosomal chaos predicts relapse, The Francis Crick Institute, Nature and the tag lung-evidence.
Shares Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Dormant cells and minimal residual disease, Minimal / molecular residual disease (MRD) and the tag lung-evidence.
Shares TRACERx first 100: tracking how lung cancers evolve, and how chromosomal chaos predicts relapse, Clonal evolution & minimal residual disease, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Tumour heterogeneity and clonal evolution and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Next-generation sequencing (NGS), The hardest cancers are found late, Liquid biopsy (ctDNA) and the tag lung-evidence.
Shares Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Dormant cells and minimal residual disease, Resectable stage I to III non-small-cell lung cancer and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Whole-exome & whole-genome sequencing, The hardest cancers are found late, Liquid biopsy (ctDNA) and the tag lung-evidence.
Shares Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.