Circulating Tumor DNA Testing in Solid Tumors and Lymphoma: ASCO Guideline

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To provide guidance on the use of circulating tumor DNA (ctDNA) testing in patients with solid tumors or lymphoma.

A systematic review by a multidisciplinary panel with patient representation was conducted. The PubMed database was searched from January 2017 to February 2025. Guideline recommendations were based on consideration of the identified evidence.

Fifty-four meta-analyses and 22 study reports were identified, including reports of seven randomized trials.

ctDNA testing for tumor genetic alterations may be used in situations where: tumor tissue testing is challenging, not feasible, or tumor biopsy represents unacceptable risks to the patient; tumor tissue testing results may not be available within a clinically actionable time frame to determine appropriate management options; or a drug's regulatory approved indication allows for or requires ctDNA testing. If ctDNA testing results are negative, inconclusive, or inconsistent with the clinical scenario, tissue-based confirmation should be sought. Other than testing for genetic alterations, ctDNA testing may be offered if a specific, evidence-based action can be taken with the results or there is conflict or ambiguity with standard-of-care assessment that may be resolved by ctDNA testing. Fractional, percentage, or concentration-based measures of ctDNA or total cell-free DNA concentration are not recommended as a surrogate measure of disease. The panel recognizes this is a rapidly evolving field and guidelines are anticipated to change, bringing in tumor-type specific recommendations and incorporating more data on molecular residual disease settings.Additional information is available at www.asco.org/molecular-testing-and-biomarkers-guidelines.