Analyzing the Role of ctDNA and Adjuvant Therapy

In this discussion, the panel examined the evolving role of circulating tumor DNA (ctDNA) in guiding adjuvant therapy for muscle-invasive bladder cancer (MIBC) following cystectomy. They reviewed data from IMvigor-010 and CheckMate 274, which demonstrated that ctDNA-positive patients face a dramatically higher relapse risk and appear to derive significant benefit from adjuvant immunotherapy (atezolizumab or nivolumab), while ctDNA-negative patients do not. The group also discussed NIAGARA trial findings, showing ctDNA’s prognostic value across treatment stages. The conversation highlighted the uncertainty around whether ctDNA-negative, pathologic complete responders still require adjuvant therapy, especially in the context of perioperative regimens like GC-durvalumab. Panelists agreed that ctDNA is a powerful biomarker for risk stratification and treatment tailoring, though its integration into clinical decision-making continues to evolve as new trials such as IMvigor-011 report outcomes.