Fig. 1: Multiplatform approach overview.

To longitudinally track the evolution of the disease, a multiplatform approach was devised that encompasses the use of ddPCR, NGS and CellSearch system on serial blood samples. Both cfDNA and CMCs were analyzed at different time points from the same blood specimen. BRAF/pTERT mutant allele fractions were longitudinally tracked by ddPCR as biomarkers of disease evolution and response to treatment, while a customized NGS panel was exploited to identify tumor genetic landscape and mutations responsible for resistance. In parallel, CMCs were phenotypically characterized and counted through the CellSearch System, and then isolated by laser capture microdissection for genetic landscape identification through NGS analysis. The workflow was created with BioRender (https://biorender.com/).