ctDNA detection post-cystectomy identifies muscle-invasive bladder cancer patients at high risk of recurrence and candidates for adjuvant immunotherapy.
The phase 3 IMvigor011 trial demonstrated that ctDNA-guided adjuvant atezolizumab significantly prolongs disease-free survival and overall survival versus placebo.
Persistent ctDNA-negative patients exhibited excellent prognosis with surveillance alone, highlighting the utility of ctDNA for treatment individualization and sparing unnecessary therapy.
Adverse events were manageable, though grade 3-4 toxicities and rare fatal events underscore the importance of patient monitoring.
