Five-Year Outlook and Closing Perspectives on ctDNA Testing

Dr. Weinberg envisions increasing ctDNA incorporation into adjuvant decision-making, anticipating that Circulate North America results will provide comfort for de-escalating ctDNA-negative patients while escalating ctDNA-positive patients.

He hopes the ctDNA-positive population becomes fertile ground for drug development, potentially accelerating large prospective adjuvant trials and opening doors to curative-intent therapy testing earlier in the treatment paradigm.

Dr. Grivas anticipates continued movement toward ctDNA-guided adjuvant decisions in bladder cancer, though emphasizing need for additional data regarding patients already exposed to neoadjuvant checkpoint inhibition, referencing ongoing perioperative trials (KEYNOTE-B15, KEYNOTE-905, NIAGARA, and the upcoming VOLGA trial) where ctDNA data could help determine whether both neoadjuvant and adjuvant components are necessary.

Dr. Teplinsky discusses breast cancer's transformational potential, noting current absence of routine asymptomatic imaging surveillance creates opportunity for ctDNA to serve as a much stronger surveillance marker within adjuvant settings, supporting both de-escalation and intensification strategies as part of the broader movement toward reducing treatment intensity when appropriate.

Dr. Raez emphasizes incorporating ctDNA into every study lacking established biomarkers, particularly relevant given immunotherapy's current biomarker limitations, framing adoption as a matter of "when" rather than "if."

Closing thoughts emphasized clinical trial enrollment as the vehicle for progress, transparent patient communication regarding risks and benefits, efficient clinic workflow implementation, and addressing global access disparities, with Dr. Grivas specifically highlighting the importance of community oncology dialogue and ensuring equitable access to both diagnostic testing and therapeutics across the globe.