Dr Linscott on the Need for Improved MRD Detection in High-Risk NMIBC

Joshua Linscott, MD, PhD, urologic oncology fellow, Moffitt Cancer Center, discusses the rationale for a study evaluating a urinary cell-free tumor DNA (utDNA) assay for minimal residual disease (MRD) detection in patients with high-risk non–muscle-invasive bladder cancer (NMIBC).

Patients with high-risk, NMIBC frequently experience disease recurrence, although progression to muscle-invasive disease is relatively uncommon, Linscott begins. Current recurrence surveillance strategies involve invasive procedures, primarily cystoscopy, conducted every 3 to 6 months until a recurrence occurs, he notes. These monitoring strategies underscore the need for more efficient and less invasive diagnostic tools that can accurately detect disease recurrence and assess the risk of progression, Linscott emphasizes. Additionally, there is a pressing need to identify predictive biomarkers that can guide treatment decisions and personalize therapeutic approaches for this population, he says. Understanding which patients are at risk of progression can inform clinical decision-making, allowing for more personalized treatment approaches, Linscott explains.

At the 2024 ASCO Annual Meeting, Linscott and colleagues presented findings from a study evaluating the use of a utDNA assay to predict MRD prior to repeat transurethral resection of bladder tumor patients with high-risk NMIBC. In this setting, patients have undergone primary tumor resection, resulting in a lower tumor burden and reduced levels of circulating cell-free DNA, according to Linscott. This scenario mirrors early recurrence, where tumor presence remains minimal, he adds. By selecting high-risk patients who have undergone initial tumor resection and are scheduled for a standard repeat resection, this study targeted those likely to harbor MRD. Accordingly, this is an ideal population for assessing the efficacy of the utDNA assay, he explains.

This study aimed to determine the accuracy and reliability of noninvasive testing for detecting residual disease in this population. Investigators hypothesized that success in this population would validate the test’s utility in identifying MRD and support its potential application for detecting early recurrence in patients with NMIBC, Linscott says.