CNAPS in therapy monitoring

Monitoring of disease state and of therapy response is highly relevant for efficient patient management. Monitoring tools comprise observation of clinical signs and performing specific examinations such as imaging or blood analyses. This review focusses on the relevance of blood-based biomarker monitoring by circulating nucleic acids for diverse indications that is exemplified on patients who develop or suffer from cancer disease. These indications include (i) screening of patient groups who have a risk to develop a disease, (ii) monitoring response to local or systemic therapies in patients with a defined diagnosis and (iii) early detection of disease recurrence after the primary therapy has ended. Useful biomarkers have to fulfill the highest methodical, pre-analytical and clinical quality criteria and have to be implemented in standardized patient management procedures. The current situation of circulating nucleic acids is summarized on the levels of genetic, epigenetic, transcript, non-coding RNA and nucleosome markers and an outlook is presented as to how these markers can be integrated into a future strategy that enables a personalized management of the patients.