Potential clinical application of free-circulating DNA from blood in renal cancer

Early diagnosis of renal cancer carcinoma is a key determinant of patient survival. The asymptomatic disease course and lack of reliable diagnostic markers lead to the fact that more than 30 % renal cancer cases discovered at an advanced stage, when the prognosis is poor because kidney tumors are resistant to standard chemotherapy and radiation. More than 30 % of renal cancer carcinoma recur or metastasize after surgical treatment. Despite the implementation of novel targeted drugs and immune point inhibitors, the 5-year survival rate for metastatic renal cancer carcinoma remains dismal. Unsatisfactory result of renal cancer treatment may be caused by high inter- and intra-tumor heterogeneity and tumor evolution during therapy, as well as the lack of predictive and on-treatment monitoring biomarkers. Liquid biopsy test that utilizes free-circulating DNA (cfDNA) in the blood of patients, opens up new opportunities for managing patients with renal cancer. The diagnostic and predictive potential of these minimally invasive biomarkers has been demonstrated for various types of cancer. The use of highly sensitive methods of cfDNA analysis may allow early cancer detection and prediction of postoperative disease recurrence before dinical and radiographic progression. Serial cfDNA samples, that were collected before and during course of treatment, can provide information about the dynamic mutational changes in the volume of the entire tumor and metastases in real time, and the emergence of drug resistance during treatment. This information may be promising toolfor optimizing patient-specific therapeutic strategies. This review is focusing on the potential clinical application of cfDNA from blood in renal cancer.