Circulating Tumor DNA Across the Patient Journey in Pancreatic Cancer: From Molecular Profiling to Dynamic Disease Monitoring
9 affiliations
- 1Department of Gastroenterology, Miyagi Cancer Center, Natori 981-1293, Miyagi, Japan
- 2Division of Cancer Stem Cell, Miyagi Cancer Center Research Institute, Natori 981-1293, Miyagi, Japan
- 3Division of Carcinogenesis and Senescence Biology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Miyagi, Japan
- 4Department of Gastroenterological Surgery, Miyagi Cancer Center, Natori 981-1293, Miyagi, Japan
- 5Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Miyagi, Japan
- 6Department of Gastrointestinal Aging Control, Healthspan Research Center, Tohoku University, Sendai 980-8575, Miyagi, Japan
- 7Division of Biomedical Research & Development, Iwate Medical University Institute for Biomedical Sciences, Yahaba 028-3694, Iwate, Japan
- 8Division of Molecular and Cellular Oncology, Miyagi Cancer Center Research Institute, Natori 981-1293, Miyagi, Japan
- 9Division of Cancer Molecular Biology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Miyagi, Japan
Abstract
Background/Objectives: Circulating tumor DNA (ctDNA) provides molecular information at different stages of the pancreatic ductal adenocarcinoma (PDAC) patient journey, but its clinical value differs according to when and why it is measured. This narrative review examines ctDNA from diagnosis and molecular profiling through neoadjuvant therapy, postoperative molecular residual disease (MRD), surveillance, and dynamic monitoring during systemic therapy, critically assessing the strength and limitations of the evidence at each clinical stage and its implications for clinical decision-making. Methods: Relevant studies were identified primarily through PubMed/MEDLINE, supplemented by forward citation tracking in Google Scholar, backward reference screening, and ClinicalTrials.gov searches for ongoing interventional studies. Original PDAC clinical studies were prioritized, with selected reviews, guidelines, consensus statements, and position papers used for context. Results: In localized disease, limited ctDNA shedding constrains diagnostic sensitivity, although baseline detection may provide prognostic information. After surgery, ctDNA positivity consistently identifies patients at increased risk of recurrence, whereas a negative result cannot reliably exclude residual disease. During surveillance, newly detectable or rising ctDNA may precede radiological recurrence. In advanced disease, serial ctDNA kinetics provide increasingly consistent information on treatment response and progression. Evidence for dynamic monitoring is increasing, but evidence that ctDNA-guided treatment or surveillance improves patient outcomes remains insufficient. Conclusions: The clinical value of ctDNA depends on when and why it is measured. ctDNA should complement rather than replace conventional assessments. By distinguishing established prognostic associations from emerging monitoring applications and unproven ctDNA-guided interventions, this review provides a practical framework for interpreting ctDNA across the PDAC patient journey. Prospective trials are needed to determine whether ctDNA-guided decisions improve patient outcomes.
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BibTeX
@article{abue2026circulating,
title = {{Circulating Tumor DNA Across the Patient Journey in Pancreatic Cancer: From Molecular Profiling to Dynamic Disease Monitoring}},
author = {Makoto Abue and Naoki Asano and Takanori Morikawa and Atsushi Masamune and Satoshi Nishizuka and Jun Yasuda},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18213471},
url = {https://www.mdpi.com/2072-6694/18/21/3471},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Circulating Tumor DNA Across the Patient Journey in Pancreatic Cancer: From Molecular Profiling to Dynamic Disease Monitoring
AU - Makoto Abue
AU - Naoki Asano
AU - Takanori Morikawa
AU - Atsushi Masamune
AU - Satoshi Nishizuka
AU - Jun Yasuda
PY - 2026
DA - 2026/10/27
JO - Cancers
DO - 10.3390/cancers18213471
UR - https://www.mdpi.com/2072-6694/18/21/3471
AB - Background/Objectives: Circulating tumor DNA (ctDNA) provides molecular information at different stages of the pancreatic ductal adenocarcinoma (PDAC) patient journey, but its clinical value differs according to when and why it is measured. This narrative review examines ctDNA from diagnosis and molecular profiling through neoadjuvant therapy, postoperative molecular residual disease (MRD), surveillance, and dynamic monitoring during systemic therapy, critically assessing the strength and limitations of the evidence at each clinical stage and its implications for clinical decision-making. Methods: Relevant studies were identified primarily through PubMed/MEDLINE, supplemented by forward citation tracking in Google Scholar, backward reference screening, and ClinicalTrials.gov searches for ongoing interventional studies. Original PDAC clinical studies were prioritized, with selected reviews, guidelines, consensus statements, and position papers used for context. Results: In localized disease, limited ctDNA shedding constrains diagnostic sensitivity, although baseline detection may provide prognostic information. After surgery, ctDNA positivity consistently identifies patients at increased risk of recurrence, whereas a negative result cannot reliably exclude residual disease. During surveillance, newly detectable or rising ctDNA may precede radiological recurrence. In advanced disease, serial ctDNA kinetics provide increasingly consistent information on treatment response and progression. Evidence for dynamic monitoring is increasing, but evidence that ctDNA-guided treatment or surveillance improves patient outcomes remains insufficient. Conclusions: The clinical value of ctDNA depends on when and why it is measured. ctDNA should complement rather than replace conventional assessments. By distinguishing established prognostic associations from emerging monitoring applications and unproven ctDNA-guided interventions, this review provides a practical framework for interpreting ctDNA across the PDAC patient journey. Prospective trials are needed to determine whether ctDNA-guided decisions improve patient outcomes.
SN - 2072-6694
ER -