Circulating Tumor DNA to Guide Treatment in Muscle-Invasive Bladder Cancer
Key Points
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Analyses of the NIAGARA and RETAIN trials support the value of circulating tumor (ctDNA) and urinary tumor DNA (utDNA) as biomarkers in patients with muscle-invasive bladder cancer (MIBC).
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Combining utDNA and ctDNA screening may provide greater insight into MIBC characteristics and help select patients for bladder-sparing treatment approaches.
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Prospective trials are still needed to validate basing treatment decisions on ctDNA or utDNA status, and to determine appropriate therapy for patients who remain positive.
Data on ctDNA and utDNA in MIBC from ASCO GU 2026
At the 2026 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU 2026), medical oncologists, Brendan Guercio, MD, of University of Rochester Medical Center, and Andrea Apolo, MD, of National Cancer Institute, discussed recent data on the role of ctDNA and utDNA in patients with MIBC.
The phase 2 RETAIN BLADDER and RETAIN-2 trials evaluated methods to select patients with MIBC for active surveillance instead of radical cystectomy after neoadjuvant chemotherapy or chemotherapy plus immunotherapy. A retrospective integrated analysis of ctDNA’s impact on outcomes in both trials was presented at ASCO GU 2026. Post-treatment ctDNA status appeared to predict metastasis-free survival, but it did not predict local-only recurrence for active surveillance patients, according to the presentation.
Dr. Apolo cited another analysis presented at ASCO GU 2026 that assessed the effect of utDNA and ctDNA in the NIAGARA trial population. The analysis found that utDNA status pre-cystectomy was more closely correlated with pathologic complete response than prior ctDNA findings. Overall, the authors suggested that combining ctDNA and utDNA analyses could improve staging and help differentiate primary and secondary tumor characteristics in patients with MIBC.
Together, these data are valuable for defining the value of ctDNA and utDNA. However, prospective trials are still needed to validate basing treatment decisions on these markers, and to inform the appropriate adjuvant therapy for patients who do not achieve negative ctDNA or utDNA after neoadjuvant treatment, said Dr. Apolo.