Asst. Prof. Nai-Jung Chiang provided additional examples from gastrointestinal cancers. In one colorectal case, initial standard hotspot testing identified a KRAS mutation, but deeper next-generation sequencing (NGS) via K-4CARE identified a different codon-level alteration (G12W), demonstrating how assay design can significantly influence interpretation. Subsequent ctDNA-MRD testing confirmed residual disease after curative intent treatment, enabling molecular risk assessment beyond imaging findings.
In a pancreatic cancer case, ctDNA detected residual disease after surgery, prompting closer surveillance and reclassifying the patient from standard-risk to molecular high-risk. The case also highlighted an ongoing challenge—low ctDNA shedding in pancreatic cancer—highlighting the demand for careful interpretation and repeat testing when appropriate.
Overall, Session II highlighted that progress will depend not only on improved tests but also on practical factors such as standardization, clinical pathways, and access. As evidence evolves, integrating tissue with ctDNA, multi-omics, and AI may help advance recurrence and resistance from late-stage discoveries into earlier, more actionable insights.
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