Author(s):
Aakash M, Premkumar G, Venkateswaramurthy N
Email(s):
nvmurthi@gmail.com
DOI:
10.52711/2321-5836.2026.00033 
Address:
Aakash M1, Premkumar G2, Venkateswaramurthy N3*
Department of Pharmacy Practice, J.K.K. Nattraja College of Pharmacy, Kumarapalayam - 638183, Namakkal District, Tamil Nadu, India.
*Corresponding Author
Published In:
Volume - 18,
Issue - 3,
Year - 2026
ABSTRACT:
Cell-free DNA (cfDNA) fragmentomics the analysis of non-random fragmentation patterns reflecting chromatin architecture and epigenetic regulation has emerged as a powerful approach for non-invasive cancer detection. While landmark studies have established the diagnostic potential of fragmentomic analysis, its application to treatment monitoring, response prediction, and minimal residual disease (MRD) detection remains incompletely synthesized. This narrative review provides the first comprehensive assessment of cfDNA fragmentomics specifically for treatment-phase applications across solid tumors. We systematically examine evidence from 2019 to 2025 demonstrating that genome-wide fragmentation profiling through approaches such as DELFI-TF (DNA EvaLuation of Fragments for early Interception Tumor Fraction) can quantify tumor burden with strong correlation to circulating tumor DNA levels (r = 0.90), predict overall survival independently of conventional biomarkers (HR = 9.84), and outperform computed tomography imaging for response assessment. We further evaluate the integration of fragmentomic features with methylation and mutational data for immunotherapy response prediction, the enhancement of MRD sensitivity from 43.5% to 78.3% through multimodal fragmentomic integration, and the emerging role of serial fragmentomic monitoring in resistance detection. Key advantages of fragmentomics based monitoring include tumor-naïve operation without prior tissue sequencing, mutation-agnostic genome-wide coverage, and cost-effectiveness through low pass whole genome sequencing. We propose a framework for clinical implementation and identify critical gaps requiring prospective validation. As fragmentomics transitions from detection to treatment navigation, it has the potential to fundamentally reshape real time, precision guided cancer management.
Cite this article:
Aakash M, Premkumar G, Venkateswaramurthy N. Cell-Free DNA Fragmentomics beyond Early Detection: A Narrative Review of Treatment Monitoring Applications in Solid Tumors. Research Journal of Pharmacology and Pharmacodynamics.2026;18(3):247-3. doi: 10.52711/2321-5836.2026.00033
Cite(Electronic):
Aakash M, Premkumar G, Venkateswaramurthy N. Cell-Free DNA Fragmentomics beyond Early Detection: A Narrative Review of Treatment Monitoring Applications in Solid Tumors. Research Journal of Pharmacology and Pharmacodynamics.2026;18(3):247-3. doi: 10.52711/2321-5836.2026.00033 Available on: https://www.rjppd.org/AbstractView.aspx?PID=2026-18-3-4
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