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Fig. 3 | Genome Medicine

Fig. 3

From: Strategies for monitoring and combating resistance to combination kinase inhibitors for cancer therapy

Fig. 3

Sequential targeted therapy assessed by longitudinal liquid biopsy. At the beginning of targeted therapy, all cells in the patient’s tumor possess an actionable genetic alteration (gray). The first treatment administered targets this first alteration. Liquid biopsy analysis demonstrates an initial decrease in the target alteration during treatment 1, yet reveals the outgrowth of an alteration causing resistance to treatment 1 (red). The red subclone can be targeted with treatment 2, where liquid biopsy analysis reveals a decrease in the frequency of resistance alteration 1. During this time, however, a third genetic alteration (blue) increases in frequency. This third mutation is resistant to treatment 2, yet is sensitive to treatment 3. During treatment 3, the frequency of the blue clone decreases, while residual clones harboring the first resistance mutation (red) may persist

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