CTC DDR genes Decision tree EGFR mutation EGFR-TKI HNSCC Medicine NGS Oncology PARP inhibitors PD-L1 TMB TNBC subtypes adjuvant chemotherapy anaplastic lymphoma receptor tyrosine kinase breast cancer cancer cancer-associated fibroblasts cfDNA chemotherapy circulating free DNA clinical guideline clonality classification comprehensive genomic profiling ctDNA digital enrichment driver mutation electronic records epidermal growth factor receptor extent of resection