Drs. Alan Tan, Brad McGregor, and Amanda Nizam discuss how ctDNA is reshaping perioperative bladder cancer management. Data from the IMvigor010 and IMvigor011 trials support using ctDNA positivity to identify patients who benefit from adjuvant immunotherapy, reframing these cases as early metastatic disease rather than traditional adjuvant settings. However, uncertainty remains around ctDNA-negative patients, optimal testing frequency, and how to integrate ctDNA with evolving perioperative regimens like EV plus pembrolizumab. The group emphasizes that while ctDNA is a powerful prognostic and predictive tool, its role in guiding escalation, de-escalation, and real-world decision making is still actively evolving.
Contributors:
Dr. Alan Tan is a medical oncologist practicing at Vanderbilt-Ingram Cancer Center in Nashville, Tennessee.
Dr. Amanda Nizam is a genitourinary medical oncologist practicing at Clevelant Clinic in Cleveland, Ohio.
Dr. Brad McGregor is a medical oncologist and the Director of Clinical Research at the Lank Center of Genitourinary Oncology in Boston, Massachusetts.