Despite emerging trial data, clinicians are not yet ready to change therapy based on ctDNA positivity alone. Key concerns cited include the absence of a proven survival benefit from early intervention, the potential to use future treatment lines prematurely, and overall feasibility. The consensus is that while promising, the technology is not yet ready for routine clinical decision-making.

While not yet validated, ctDNA is being used by clinical experts as a de-escalation tool to provide confidence when stopping long-term maintenance therapies like PARP inhibitors. This novel application focuses on reducing treatment burden rather than solely detecting disease progression.

While ctDNA testing offers powerful prognostic information, some patients decline it. The key reason is the anxiety associated with receiving a positive result after adjuvant therapy when there is no standard-of-care intervention for MRD positivity. For these patients, the psychological burden of knowing about likely recurrence without a clear action plan outweighs the benefit.

An expert oncologist advises against ordering ctDNA tests that merely provide a "good or a bad feeling" about prognosis. The most valuable use is when a positive or negative result clearly dictates a clinical action, such as when to stop or restart adjuvant therapy.

A positive ctDNA test indicating minimal residual disease is strongly linked to recurrence. This expert argues clinicians have an obligation to act on this information, even without definitive guidelines. Framing inaction as unacceptable challenges the passive "wait-and-see" approach.

Despite significant interest, circulating tumor DNA (ctDNA) is not yet an actionable tool for guiding the duration of maintenance immunotherapy in endometrial cancer. While studies like DuoE show ctDNA levels correlate with outcomes, there is no evidence to support using its clearance to decide when to stop treatment. It remains a prognostic, not a predictive, biomarker for this purpose.

While patients increasingly ask about ctDNA, clinicians are hesitant to use it for treatment decisions in ovarian cancer management. A rising ctDNA level may prompt more vigilant surveillance but does not yet trigger treatment initiation, as its correlation with survival outcomes is unproven.

Oncologists are more comfortable using a positive ctDNA test to escalate care (e.g., recommend chemo for a low-risk Stage II patient). However, they are more hesitant to use a negative test to de-escalate or withhold standard chemo for higher-risk patients, pending more definitive trial data.

Contrary to some physicians' concerns, patient survey data shows that over 80% value ctDNA testing. They perceive it not as a source of anxiety, but as a way to be proactive in their care. This finding dismantles a key argument used by some clinicians to resist adoption.