What does this research mean for the field?

Circulating tumor DNA (ctDNA) testing is increasingly adopted in routine oncology practice, predominantly for minimal residual disease (MRD) monitoring, and actively informs decisions regarding the continuation or discontinuation of anticancer pharmacotherapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to understand the real-world uptake of ctDNA testing across diverse cancer patient demographics and clinical contexts.

May 30, 2026

Understanding circulating tumor DNA (ctDNA) test uptake among diverse cancer patients: A real-world evidence study.

Key Points

This study aims to understand the real-world uptake of ctDNA testing across diverse cancer patient demographics and clinical contexts.
Conducted a retrospective cohort study of patients from a clinical data warehouse between 2019 and 2025.
Analyzed demographic characteristics and clinical documentation related to ctDNA testing using an LLM-based extraction pipeline.
Extracted data included testing recommendations, orders, and reported results.
Out of 2,250 patients who discussed or underwent ctDNA testing, 86.2% were for MRD monitoring.
Only 10.5% of patients tested had positive ctDNA results while 21.1% were negative.
Among ctDNA-positive patients receiving treatment, 41.4% continued treatment, whereas 58.1% of ctDNA-negative patients discontinued.

Abstract

e23374 Background: Circulating tumor DNA (ctDNA) testing is increasingly used in oncology for clinical indications including minimal residual disease (MRD) assessment and blood-based comprehensive genomic profiling (CGP). An understanding of real-world ctDNA utilization across cancer types, metastatic status, and clinical contexts is essential for optimal cancer care. Methods: Using the de-identified UCSF Clinical Data Warehouse (CDW), we conducted a retrospective cohort study of patients with documentation indicating ctDNA testing being discussed or performed between 2019 and 2025. Demographic characteristics, primary cancer type, and metastatic status were extracted from structured EHR data. Clinical documentation related to ctDNA was analyzed using an LLM-based extraction pipeline on UCSF Versa (ChatGPT on Microsoft Azure) to classify ctDNA-related statuses, including testing recommendation, test ordering, and reported results (positive, negative, inconclusive). Results: We identified 2,250 patients who underwent or discussed ctDNA testing, with 78.5% occurring in 2022 or later; indications were predominantly for MRD monitoring (86.2%), with 13.8% for CGP. Patients were predominantly aged 55–74 years (48.3%), male (55.7 %), non-Hispanic White (59.1%), and had metastatic disease at the initial ctDNA testing or discussion (38.3%). Gastrointestinal cancers were the most common tumor type for both MRD (27.7%) and CGP (20.3%). Among 1,940 patients with MRD-indicated ctDNA testing or discussion, ctDNA results were available for those tested, of whom 204 (10.5%) were positive and 409 (21.1%) were negative. Among the 94 ctDNA-positive patients who received anticancer pharmacotherapy at UCSF, 39 (41.4%) continued treatments after the last available ctDNA result. In comparison, among 179 ctDNA-negative patients who received anticancer pharmacotherapy, 104 (58.1%) discontinued treatments. Overall, our findings highlight the growing role of ctDNA in informing treatment decisions in routine oncology practice. Conclusions: In this real-world academic hospital cohort, ctDNA testing was predominantly used for MRD monitoring, with discussion and testing trends reflecting its increasing adoption in oncology practice.

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