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Article History

Received: 23 January 2019

Accepted: 15 October 2019

First Online: 25 November 2019

Competing interests

: P.R. reports consulting and serving on the advisory board for Novartis, as well as receiving institutional research support from Illumina and GRAIL. B.T.L. reports consulting and serving on the advisory board for Genentech, Thermo Fisher Scientific, Guardant Health, Hengrui Therapeutics, Mersana Therapeutics and Biosceptre Australia, as well as receiving institutional research support from Illumina, GRAIL, Genentech and AstraZeneca. W.A. reports consulting and advising for Clovis Oncology, Janssen, ORIC Phamaceuticals and MORE Health, as well as receiving honoraria from CARET, institutional research support from AstraZeneca, Zenith Epigenetics, Clovis Oncology and GlaxoSmithKline, and travel, accommodation and expenses from GlaxoSmithKline and Clovis Oncology. J.M.I. holds equity in LumaCyte and has received institutional research support from GRAIL and Guardant Health. G.P. is on the Scientific Advisory Board for Tizona Therapeutics and has consulted for Merck, Bristol-Myers Squibb and Kyowa Hakko Kirin. D.M.H. reports stock and other ownership interests in Fount, as well as consulting and advising for Chugai Pharmaceutical, Boehringer Ingelheim, AstraZeneca, Pfizer, Bayer, Genentech and Fount. He has also received research funding from AstraZeneca, Puma Biotechnology, Loxo and Bayer, and travel, accommodation and expenses from Genentech and Chugai Pharmaceutical. G.J.R. received consulting fees from Genentech/Roche in 2016, as well as institutional research support for clinical research from Pfizer, Roche/Genentech and Takeda. C.M.R. has consulted on oncology drug development for AbbVie, Amgen, Ascentage, AstraZeneca, Bicycle, Celgene, Chugai, Daiichi Sankyo, Genentech/Roche, G1 Therapeutics, Loxo, Novartis, Pharmamar and Seattle Genetics. He is also on the scientific advisory boards of Harpoon Therapeutics and Elucida Oncology. L.A.D. is a member of the board of directors of Personal Genome Diagnostics (PGDx) and Jounce Therapeutics, and is a paid consultant for PGDx and NeoPhore. He is also an uncompensated consultant for Merck, but has received research support for clinical trials from Merck. At Johns Hopkins University, he is an inventor of multiple licensed patents related to technology used for circulating tumor DNA analyses and mismatch repair deficiency for diagnosis and therapy. Some of these licenses and relationships are associated with equity or royalty payments made directly to L.A.D. and Johns Hopkins University. He also holds equity in PGDx, Jounce Therapeutics, Thrive Earlier Detection and NeoPhore. His spouse holds equity in Amgen. The terms of all of these arrangements are being managed by Johns Hopkins University and the Memorial Sloan Kettering Cancer Center in accordance with their conflict of interest policies. D.B.S. received honoraria and/or consulted for Pfizer, Loxo Oncology, Illumina, Intezyne and Vividion Therapeutics. J.S.R.-F. reports receiving personal/consultancy fees from VolitionRx, Paige.AI, Goldman Sachs, REPARE Therapeutics, GRAIL, Ventana Medical Systems, Roche, Genentech and InviCRO outside of the scope of the submitted work. B.J., E.H., C.H., O.V., T.M., S.G., R.V.S., Q.L., L.S., N.E., J.Y., A.W.B., M. Lee, A.S., H.X., M.P.H., W.F.N. and A.M.A. are (or were) GRAIL employees and hold stock and/or other ownership interests in GRAIL. A.W.B. additionally reports Foresite ownership interest. The other authors declare no competing interests.