ctDNA in the Perioperative Setting

This segment focuses on the evolving role of ctDNA in the context of perioperative therapy, particularly with enfortumab vedotin plus pembrolizumab (EVP). Panelists discuss how ctDNA can identify patients at high risk of recurrence following neoadjuvant therapy and cystectomy, even when imaging and pathology appear favorable. Persistent ctDNA positivity is viewed as a marker of residual disease, raising questions about the need for treatment intensification. Conversely, ctDNA-negative patients may represent a group that could potentially avoid additional therapy, though evidence to support de-escalation remains limited. Clinicians emphasize that, despite the promise of ctDNA, current practice continues to follow clinical trial protocols rather than biomarker-driven decisions. Ongoing studies, including MRD-guided trials, are expected to clarify how ctDNA can inform perioperative treatment strategies and optimize outcomes in bladder cancer.