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Table 3. The potential clinical utility of extrachromosomal circular DNA elements in cancer patients

From: Current understanding of extrachromosomal circular DNA in cancer pathogenesis and therapeutic resistance

Clinical applications Refs
• Change the levels of extrachromosomal oncogenes influence the treatment efficacy  
(i) Reemergence of clonal EGFRvIII mutations on DMs resensitizes cancer cells to anti-EGFR inhibitors [128]
(ii) Treatment with chemotherapeutic drugs accelerates the loss of extrachromosomally amplified genes [137]
(iii) Elimination of extrachromosomal genes increases the drug sensitivity [133]
• Extrachromosomal DNA serves as the ideal biomarkers for clinical monitoring  
(i) Cancer-derived EVs carrying extrachromosomal DNA can transfer the fragments of some oncogenes and trigger malignant progression [141]
(ii) Circular DNA elements can be detected in the blood-based screening of plasma from cancer patients as a component of liquid biopsy [150]
(iii) Significantly decreased extrachromosomal circular DNA in circulation following tumor resection in cancer patients [94]