{"entity":{"id":"ctdna-mrd-to-adjuvant","kind":"pairing","name":"ctDNA MRD → adjuvant therapy decision","aka":[],"tldr":"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.","asOf":"2026-09-04","links":[{"label":"ClinicalTrials.gov NCT04660344: IMvigor011","url":"https://clinicaltrials.gov/study/NCT04660344"},{"label":"ClinicalTrials.gov ACTRN12615000381583: DYNAMIC","url":"https://clinicaltrials.gov/study/ACTRN12615000381583"}],"tags":[],"related":[],"cancers":["urothelial","colorectal","tnbc"],"sections":[],"technologies":[],"targets":[],"drugs":["atezolizumab","signatera"],"companies":[],"institutions":[],"pathways":[],"terms":["mrd"],"trials":["imvigor011","dynamic"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"a":"mrd-testing","b":"checkpoint-inhibitor","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).","pairingType":"diagnostic-therapeutic"},"route":"/pairings/ctdna-mrd-to-adjuvant/","neighbours":{"cancer":[{"id":"urothelial","kind":"cancer","name":"Bladder & urothelial cancer","route":"/cancers/urothelial/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"drug":[{"id":"atezolizumab","kind":"drug","name":"Atezolizumab","route":"/drugs/atezolizumab/"},{"id":"signatera","kind":"drug","name":"Signatera","route":"/drugs/signatera/"}],"term":[{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"}],"trial":[{"id":"circulate-us","kind":"trial","name":"CIRCULATE-US","route":"/trials/circulate-us/"},{"id":"dynamic","kind":"trial","name":"DYNAMIC","route":"/trials/dynamic/"},{"id":"imvigor011","kind":"trial","name":"IMvigor011","route":"/trials/imvigor011/"}],"technology":[{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"idea":[{"id":"idea-ctdna-escalation-tnbc","kind":"idea","name":"ctDNA-triggered escalation in early TNBC","route":"/ideas/idea-ctdna-escalation-tnbc/"},{"id":"idea-tr2-ctdna-mrd-qualification","kind":"idea","name":"Formally qualify tumour-DNA blood tests as a surrogate endpoint for adjuvant trials","route":"/ideas/idea-tr2-ctdna-mrd-qualification/"}],"paper":[{"id":"paper-dynamic-nejm-2022","kind":"paper","name":"DYNAMIC: a blood test safely halved chemotherapy use after surgery for stage II colon cancer","route":"/key-papers/paper-dynamic-nejm-2022/"},{"id":"paper-imvigor011-nejm-2025","kind":"paper","name":"IMvigor011: using a blood test for leftover cancer to decide who gets immunotherapy after bladder surgery","route":"/key-papers/paper-imvigor011-nejm-2025/"}],"roadmap":[{"id":"ctdna-tests","kind":"roadmap","name":"ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment","route":"/roadmaps/ctdna-tests/"}]}}