Pancreatic ductal adenocarcinoma is a devastating disease which is associated with an increase in cancer-related death in the USA. The minority of patients are cured by surgery alone and typically require adjuvant chemotherapy in order to improve clinical outcomes. Circulating tumor DNA (ctDNA) is an emerging technology whereby microscopic levels of minimal residual disease (MRD) can be detected in the bloodstream. Circulating KRAS mutations are frequently studied given that they are present in over 90% of pancreatic cancers. Other assays utilize whole exome sequencing and/or methylomics to detect MRD. We demonstrate that ctDNA has prognostic and predictive capabilities in patients with both resectable and unresectable pancreatic ductal adenocarcinoma. ctDNA opens the door to novel therapeutic options and is already being integrated into ongoing clinical trials.
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