Molecular profiling-directed individualized adjuvant therapy in colorectal cancer: Bridging consensus guidelines to clinical disparities

Figure 2 A dynamic and adaptable precision medicine framework for colorectal cancer adjuvant care. This model integrates tiered molecular profiling at diagnosis (ranging from core biomarker testing to comprehensive multi-omics based on resource availability) with adaptable longitudinal circulating tumor DNA (ctDNA) monitoring (with cadences adjustable to local capacities) to guide personalized therapy. The entire process is supported by an enabling foundation of real-world data and health policy, and driven by artificial intelligence and MDT 2.0 for collaborative decision-making. The system enables adaptive intervention for ctDNA-positive (minimal residual disease) patients or de-escalated management for ctDNA-negative patients, facilitating a continuous cycle of personalized care. The framework is designed to be implemented across a spectrum of resource settings through prioritized testing, tiered algorithms, and flexible monitoring cadences, ensuring practicality in diverse healthcare environments from high-resource centers to resource-constrained clinics. AI: Artificial intelligence; ctDNA: Circulating tumor DNA.