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ASCO GI 2026 | ctDNA adoption in the US: sensitivity limitations and cost barriers remain
Emerik Osterlund, MD, PhD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the adoption of circulating tumor DNA (ctDNA) testing for patients with colorectal cancer (CRC) in the United States.ctDNA is approved as standard of care in the US, with some hospitals actively using it for patient follow-up and minimal residual disease (MRD) trials. However, methodology limitations and lack of sensitivity make some clinicians reluctant to rely heavily on it. Cost is also a barrier in some regions, particularly when CT scans are already used. Better, cheaper assays will likely increase future implementation. This interview took place at the 2026 American Society of Clinical Oncology Gastrointestinal Cancers Symposium in San Francisco, CA.
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Transcript
In the US, ctDNA has already been approved as part of standard of care, and some hospitals have adopted ctDNA testing and use it quite actively in the follow-up of patients and also for MRD trials. But still, I would say the limitations of the methodology and the lack of sensitivity make some people still reluctant to rely a lot on ctDNA...
In the US, ctDNA has already been approved as part of standard of care, and some hospitals have adopted ctDNA testing and use it quite actively in the follow-up of patients and also for MRD trials. But still, I would say the limitations of the methodology and the lack of sensitivity make some people still reluctant to rely a lot on ctDNA. So I think better assays are certainly part of it.
In some parts of the world, I think the cost is also an aspect to consider, where we’re already doing CT scans, so adding another method on top that can cost quite a lot is a hurdle. But I think with better methodologies, when it becomes cheaper over time, it’s probably more and more implementable in the future as well.
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