Fig. 4

Identification of longitudinally trackable driver mutations in ctDNA. A Oncoprint showing patients with ctDNA mutations in PDAC drivers (KRAS, TP53, SMAD4, CDKN2A) and known RAS family genes (NRAS, HRAS) in plasma. The percentage of altered cases is displayed to the right. Lollipop plots displaying the mutations detected in ctDNA are shown alongside the oncoprint. B-F In patients with multiple plasma samples, the mean mutant allele fraction (MAF) was calculated for all mutation loci in ctDNA (patient-specific plus ctDNA variants in known PDAC drivers), at each timepoint. Available measurements of CA19-9 across serial timepoints for each patient are also shown. Examples of patient-specific ctDNA mutations observed in each case are displayed on the right (missense variants (circles), nonsense variants (triangles), CdsStartCNV variants (squares)). In two patients, temporal heterogeneity between ctDNA mutations in RAS and IDH genes was detected E, F. CdsStartCNV; single nucleotide variant at coding start; CAP, Capecitabine; CHEMORAD (CAP), Chemoradiation (with Capecitabine); GEM, Gemcitabine