Journal: Molecular cancer
This is a narrative review on how integrated multi-omics and liquid biopsy are reshaping the understanding and management of gastrointestinal (GI) cancers.
Key points:
- Clinical problem
GI cancers remain highly lethal due to late diagnosis, marked molecular heterogeneity, therapy resistance, and recurrence.
Traditional clinicopathologic features and single-omics (e.g., genomics alone) do not adequately capture the biological complexity that drives outcomes.
- Role of integrated multi-omics
The review highlights how combining genomics, epigenomics, transcriptomics, proteomics, metabolomics, and spatial profiling enables:
- Earlier and more accurate detection.
- More refined molecular subtyping beyond current histologic or single-omics classifications.
- Individualized risk stratification to guide treatment intensity and surveillance.
- Liquid biopsy and minimal residual disease (MRD)
Circulating tumor DNA (ctDNA) is discussed as a tool for:
- Post-operative MRD assessment.
- Dynamic monitoring of recurrence risk.
- Informing adjuvant treatment decisions and post-treatment surveillance strategies.
- Tumor microenvironment and immunotherapy
Multi-omics characterization of the tumor microenvironment is presented as a way to:
- Better predict immunotherapy response.
- Rationally design combination regimens (e.g., immunotherapy plus targeted agents or other systemic therapies) in GI malignancies.
- Targeted therapy and novel vulnerabilities
By defining molecular subtypes and pathway dependencies more precisely, multi-omics is expected to:
- Expand the range of actionable targets.
- Support development of new targeted agents and biomarker-driven clinical trials in GI cancers.
- Barriers and future directions
The review outlines current obstacles to broad clinical adoption, including cost, data integration/analysis, standardization, and translation into routine workflows.
It emphasizes that, despite these barriers, accumulating omics data are moving GI oncology toward genuine precision medicine, with implementation strategies and validation still evolving.
Overall, the article positions integrated multi-omics and ctDNA-based approaches as central to the next phase of precision oncology in GI cancers, particularly for early detection, refined prognostication, MRD-guided management, and optimizing immuno- and targeted therapies.