Lars Dyrskjøt, Professor at Aarhus University, shared on LinkedIn:

“ctDNA-Guided Therapy in Bladder Cancer — Ready?

The IMvigor011 trial provides prospective, randomized evidence that circulating tumor DNA (ctDNA) can be used to guide adjuvant immunotherapy after cystectomy in muscle-invasive bladder cancer.

The data indicate that:

Patients with persistently ctDNA-negative status have excellent outcomes without adjuvant therapy, supporting treatment de-escalation.
ctDNA-positive patients have a clinically meaningful disease-free survival benefit from adjuvant immunotherapy.
Biomarker-driven risk stratification may outperform traditional pathology-based treatment algorithms.

At the same time, important questions remain regarding implementation: how to safely de-escalate treatment in high-risk patients, how frequently ctDNA should be assessed, required sensitivity of ctDNA assays, and how ctDNA-guided strategies should be integrated with evolving perioperative approaches.

These findings align with ongoing studies such as TOMBOLA, which is exploring ctDNA-guided treatment escalation across both high- and lower-risk patients and may further inform how biologic risk stratification can be applied in routine care.”

Title: ctDNA-Guided Adjuvant Atezolizumab in Muscle-Invasive Bladder Cancer

Authors: Thomas Powles, Ariel G. Kann, Daniel Castellano, Marine Gross-Goupil, Hiroyuki Nishiyama, Sergio Bracarda, Jørgen Bjerggaard Jensen, Lydia Makaroff, Shusuan Jiang, Ja Hyeon Ku, Se Hoon Park, Oscar Reig Torras, Dingwei Ye, Marco Maruzzo, Andrea Necchi, Rafael Morales-Barrera, Emilio Francesco Giunta, Jae Lyun Lee, Giampaolo Tortora, Yüksel Ürün, Lukasz Dolowy, Dilek Erdem, Alvaro Pinto, Fabricio Grando, Wei Zou, Zoe June Assaf, Jacqueline Vuky, Viraj Degaonkar, Elizabeth E. Steinberg, Joaquim Bellmunt, Jürgen E. Gschwend

Read the Full Article in Journal of Extracellular Vesicles.

Lars Dyrskjøt: ctDNA-Guided Therapy in Bladder Cancer - Ready?
Title: ctDNA-Guided Therapy in Bladder Cancer — Ready?