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

• 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

(ii) Treatment with chemotherapeutic drugs accelerates the loss of extrachromosomally amplified genes

(iii) Elimination of extrachromosomal genes increases the drug sensitivity

• 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

(ii) Circular DNA elements can be detected in the blood-based screening of plasma from cancer patients as a component of liquid biopsy

(iii) Significantly decreased extrachromosomal circular DNA in circulation following tumor resection in cancer patients