# ctDNA MRD → adjuvant therapy decision

Source: https://onco.cc/pairings/ctdna-mrd-to-adjuvant/  
OnCo record `ctdna-mrd-to-adjuvant` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A ctDNA MRD blood test after surgery decides who gets more treatment and who is spared it.

## Summary

This diagnostic-therapeutic pairing links MRD / molecular residual disease testing to the adjuvant decision, here with Immune checkpoint inhibitors: a ctDNA blood test after surgery decides who gets more treatment and who is spared it. Minimal / molecular residual disease (MRD) identifies the minority who will relapse, concentrating toxic therapy where it helps. In phase 3 IMvigor011, Atezolizumab given only to ctDNA-positive Bladder & urothelial cancer patients improved survival and was approved in 2026; in the randomised phase 2 DYNAMIC trial, ctDNA-negative Colorectal cancer patients safely skipped chemotherapy. It is being tested in Triple-negative breast cancer (TNBC) after KEYNOTE-522, in NSCLC and in breast cancer (ZEST, c-TRAK), often with Signatera.

## Fields

- Kind: Pairing
- Last checked: 2026-09-04
- Pairs: MRD / molecular residual disease testing + Immune checkpoint inhibitors
- Type: diagnostic-therapeutic
- Rationale: MRD identifies the ~30-40% who will relapse, concentrating toxic therapy where it helps and sparing the rest.
- Evidence: Phase 3 (IMvigor011) and randomised phase 2 (DYNAMIC).

## Sources

- ClinicalTrials.gov NCT04660344: IMvigor011: https://clinicaltrials.gov/study/NCT04660344
- ClinicalTrials.gov ACTRN12615000381583: DYNAMIC: https://clinicaltrials.gov/study/ACTRN12615000381583

## Connected records

- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- drugs: [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Signatera](https://onco.cc/drugs/signatera/)
- terms: [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/)
- trials: [CIRCULATE-US](https://onco.cc/trials/circulate-us/), [DYNAMIC](https://onco.cc/trials/dynamic/), [IMvigor011](https://onco.cc/trials/imvigor011/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- ideas: [ctDNA-triggered escalation in early TNBC](https://onco.cc/ideas/idea-ctdna-escalation-tnbc/), [Formally qualify tumour-DNA blood tests as a surrogate endpoint for adjuvant trials](https://onco.cc/ideas/idea-tr2-ctdna-mrd-qualification/)
- key papers: [DYNAMIC: a blood test safely halved chemotherapy use after surgery for stage II colon cancer](https://onco.cc/key-papers/paper-dynamic-nejm-2022/), [IMvigor011: using a blood test for leftover cancer to decide who gets immunotherapy after bladder surgery](https://onco.cc/key-papers/paper-imvigor011-nejm-2025/)
- roadmaps: [ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment](https://onco.cc/roadmaps/ctdna-tests/)

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