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ONCOLOGY, NUCLEAR MEDICINE AND TRANSPLANTOLOGY
Review Article
Sep 06, 2026 18 12

Extrachromosomal DNA in Adaptive Tumour Evolution: Mechanisms Driving Plasticity, Drug Resistance and Precision Oncology

Verity Ghansah 1,
Yemisi Omotoyosi Adetayo 2,
Oluwabukunmi M. Oluwaniran 3,
Lydia Amarachi Onwuemelem 4 *
1 Department of Biology, New Mexico Institute of Mining and Technology, Socorro, NM, USA2 Department of Medical Laboratory Science, General Hospital Ikorodu, Lagos, Nigeria3 Department of Anatomic Pathology, Federal Medical Center, Abeokuta, Nigeria4 Department of Medical Laboratory Science, University of Benin, Benin City, Nigeria* Corresponding Author
Oncology, Nuclear Medicine and Transplantology, 2(3), 2026, onmt028, https://doi.org/10.63946/onmt/19225
Publication date: Sep 06, 2026
Full Text (PDF)

ABSTRACT

Extrachromosomal DNA (ecDNA) has been identified as a critical component of tumour evolution, offering a dynamic genetic and regulatory landscape through which cancer cells can alter oncogene dosage, transcriptional states, and cellular phenotypes. Lacking centromeric and telomeric sequences, ecDNA is inherited in a non-Mendelian manner, resulting in substantial cell-to-cell variation in ecDNA copy number and composition. The aim of this review is to synthesize the biogenesis, molecular organization, and functional consequences of ecDNA, focusing on its role in tumour plasticity, adaptive evolution, therapeutic resistance and clinical translation. This narrative review synthesizes literature identified through structured searches of PubMed, Web of Science, Scopus, and Google Scholar covering publications from 2017 to August 2026, with emphasis on mechanistic and translational studies of cancer-associated ecDNA. Evidence indicates that ecDNA acts as a dynamic source of oncogenic amplification and cellular diversity, enabling rapid shifts in tumour states under selective pressure. These properties may help explain its association with disease progression and treatment failure, while emerging technologies are beginning to reveal opportunities for ecDNA-informed therapeutic intervention. Even with significant advances, one of the major problems is the ability to differentiate the biological effects specific to ecDNA from the effects that are due to high level amplification of oncogenes and genomic instability in general. An Integrative multi-dimensional approach will be crucial to uncover causal mechanisms and to advance the field of ecDNA-guided precision oncology.

KEYWORDS

Oncogene Dosage Intratumoural Heterogeneity Chromatin Architecture Enhancer Hijacking Non-Mendelian Inheritance Therapeutic Adaptation

CITATION (Vancouver)

Ghansah V, Adetayo YO, Oluwaniran OM, Onwuemelem LA. Extrachromosomal DNA in Adaptive Tumour Evolution: Mechanisms Driving Plasticity, Drug Resistance and Precision Oncology. Oncology, Nuclear Medicine and Transplantology. 2026;2(3):onmt028. https://doi.org/10.63946/onmt/19225
APA
Ghansah, V., Adetayo, Y. O., Oluwaniran, O. M., & Onwuemelem, L. A. (2026). Extrachromosomal DNA in Adaptive Tumour Evolution: Mechanisms Driving Plasticity, Drug Resistance and Precision Oncology. Oncology, Nuclear Medicine and Transplantology, 2(3), onmt028. https://doi.org/10.63946/onmt/19225
Harvard
Ghansah, V., Adetayo, Y. O., Oluwaniran, O. M., and Onwuemelem, L. A. (2026). Extrachromosomal DNA in Adaptive Tumour Evolution: Mechanisms Driving Plasticity, Drug Resistance and Precision Oncology. Oncology, Nuclear Medicine and Transplantology, 2(3), onmt028. https://doi.org/10.63946/onmt/19225
AMA
Ghansah V, Adetayo YO, Oluwaniran OM, Onwuemelem LA. Extrachromosomal DNA in Adaptive Tumour Evolution: Mechanisms Driving Plasticity, Drug Resistance and Precision Oncology. Oncology, Nuclear Medicine and Transplantology. 2026;2(3), onmt028. https://doi.org/10.63946/onmt/19225
Chicago
Ghansah, Verity, Yemisi Omotoyosi Adetayo, Oluwabukunmi M. Oluwaniran, and Lydia Amarachi Onwuemelem. "Extrachromosomal DNA in Adaptive Tumour Evolution: Mechanisms Driving Plasticity, Drug Resistance and Precision Oncology". Oncology, Nuclear Medicine and Transplantology 2026 2 no. 3 (2026): onmt028. https://doi.org/10.63946/onmt/19225
MLA
Ghansah, Verity et al. "Extrachromosomal DNA in Adaptive Tumour Evolution: Mechanisms Driving Plasticity, Drug Resistance and Precision Oncology". Oncology, Nuclear Medicine and Transplantology, vol. 2, no. 3, 2026, onmt028. https://doi.org/10.63946/onmt/19225

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