Plasma over tissue? Liquid biopsy in the management of gastrointestinal stromal tumors (GISTs)

Gastrointestinal stromal tumors (GISTs) are widely regarded as a paradigm of precision oncology, primarily due to their well-characterized molecular drivers and the availability of effective targeted therapies. Thus, GISTs represent an ideal candidate for personalized approaches leveraging liquid biopsy. Liquid biopsy allows the detection of tumor-derived biomarkers containing genomic information in body fluids, mainly blood: circulating tumor cells, circulating free DNA and RNA, circulating tumor DNA, tumor-derived extracellular vesicles, exosomes and tumor-educated platelets. Moreover this technique offers significant advantages compared to tissue biopsy, including reduced invasiveness, faster turnaround times, lower costs and, consequently, repeatability. All these features contribute to making liquid biopsy ideal for several clinical applications, such as real-time monitoring of treatment efficacy and onset of resistance mutations. Accumulating evidence over the years has supported the application of liquid biopsy in GIST patients, culminating in its inclusion in large clinical trials. Therefore, the aim of this review is to critically evaluate the advantages and limitations of liquid biopsy technologies in the context of GIST research to highlight current challenges and guide improvements in future studies. • Liquid biopsy is a non-invasive, fast technique suitable for repeated clinical use • GISTs are an ideal candidate for liquid biopsy given their molecular profile • Liquid biopsy monitors GIST resistance events, therapy response and residual disease • Liquid biopsy use in clinical practice remains limited by technical challenges