PMC6095987_01
Timeline of patient's treatment, follow-up and ctDNA mutation levels during disease progression. The upper panel shows the frequencies of tumor mutations detected in each plasma sample, and hepatic lesion size throughout the course of palliative chemotherapy. An increase in KRAS and TP53 mutation frequencies observed in PS4 preceded significant increases in tumor marker frequencies in PS5 and PS6. Sequential CT measurements were suggestive of disease stability throughout the treatment period. The lower panel shows the patient's course of treatment (FOLFOX followed by FOLFIRI) with surgery date and serial PS collection. PS, plasma sample; CT, computed tomography; *, patient death.
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F1
The remaining five additional plasma samples, PS2-6, were collected monthly, starting 1 month after the beginning of chemotherapy (Figure 1). TP53 decreased significantly, dropping below the 1% detection cut-off of by PS2 (Figure 1). ctDNA mutations remained undetectable by NGS in PS3. The noticeable decrease in allele frequency mutations after primary tumor resection and during palliative chemotherapy can be related to a response to treatment. The timeline of the patient's peripheral blood collection, palliative chemotherapy, and follow-up scheme, as well as the ctDNA identification through NGS, along with their frequencies, are shown in Figure 1.