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Opinion|Videos|May 11, 2026

ctDNA in Metastatic Urothelial Carcinoma

Author(s)Pooja Ghatalia, M.D. , Steven Seyedin, M.D. , Arnab Basu, M.D.

Experts explain how ctDNA tracking in metastatic cancer helps tailor immunotherapy, spot relapse early, and guide dose breaks—plus key limitations.

Episodes in this series

Experts featured in this series.

EP. 1 Early Adoption of ctDNA in Muscle-Invasive Bladder Cancer

Experts featured in this series.

EP. 2 Integrating ctDNA Into Clinical Decision-Making

Experts featured in this series.

EP. 3 ctDNA in the Perioperative Setting

Experts featured in this series.

EP. 4 Practical Considerations for ctDNA Testing

Experts featured in this series.

EP. 5 ctDNA in Chemoradiotherapy and Bladder Preservation

Experts featured in this series.

EP. 6 Emerging Role of Urinary Tumor DNA (utDNA)

Experts featured in this series.

EP. 7 ctDNA in Metastatic Urothelial Carcinoma

Experts featured in this series.

EP. 8 Expanding ctDNA Applications to RCC and Germ Cell Tumors

This segment examines the use of ctDNA in metastatic urothelial carcinoma, particularly for monitoring treatment response and guiding therapeutic decisions. Panelists describe how ctDNA dynamics often correlate with clinical and radiographic outcomes, with rapid declines indicating favorable response and persistent positivity suggesting resistance. ctDNA is also used to support decisions around treatment de-escalation, especially in patients experiencing toxicity from regimens such as enfortumab vedotin plus pembrolizumab. Additionally, ctDNA may detect molecular recurrence earlier than imaging, allowing for more timely intervention. However, clinicians caution that ctDNA has limitations, including reduced sensitivity in certain metastatic sites. Overall, this segment highlights ctDNA as a promising real-time biomarker in advanced disease, with growing clinical utility in personalized treatment management.

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