{"entity":{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","aka":[],"tldr":"An ultra-sensitive blood test after surgery that detects leftover cancer months before a scan would.","summary":"Tumour-informed assays (Signatera, Oncodetect, RaDaR) or tumour-naive assays (Guardant Reveal) detect ctDNA after curative treatment. ctDNA positivity predicts recurrence with high specificity. Trials (DYNAMIC, CIRCULATE, IMvigor011 in bladder cancer, positive in 2025-26 leading to atezolizumab approval in ctDNA+ MIBC) show it can guide adjuvant therapy. Standard in haematologic malignancies via flow cytometry and NGS (clonoSEQ).","status":"established","asOf":"2026-09-04","wikipedia":"https://en.wikipedia.org/wiki/Minimal_residual_disease","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Minimal_residual_disease"}],"tags":[],"related":["ctdna-tests","idea-dtc-colonisation-determinants","idea-dormancy-maintenance-therapy"],"cancers":["colorectal","urothelial","tnbc","nsclc","multiple-myeloma"],"sections":["diagnostics"],"technologies":[],"targets":[],"drugs":[],"companies":["natera","exact-sciences","guardant-health","adela","billiontoone","c2i-genomics","haystack-oncology","inivata","isabl","mission-bio","naveris"],"institutions":[],"pathways":[],"terms":["mrd","ctdna"],"trials":["imvigor011","dynamic"],"people":[],"bottlenecks":[],"keyPapers":["paper-tie-ctdna-minimal-residual-disease-stage-ii-colon-sci-transl-med-2016","paper-reinert-ctdna-ultradeep-sequencing-colorectal-jama-oncol-2019","paper-henriksen-ctdna-stage-iii-colorectal-improve-it-ccr-2022","paper-dynamic-nejm-2022","paper-galaxy-signatera-nat-med-2023"],"journals":[],"dependsOn":["liquid-biopsy","ngs-bioinformatics-software"],"notes":["Colorectal cancer: the founding disease for tumour-informed residual disease testing. Postoperative detection carries recurrence hazard ratios of 7 to 18, detection after adjuvant chemotherapy 17 to 51, and serial surveillance up to 43, with lead times over imaging of about 10 to 16 months (Tie 2016, Reinert 2019, Henriksen 2022). DYNAMIC is the only randomised trial in any solid tumour to change treatment on the result, cutting adjuvant chemotherapy from 28% to 15% in stage II colon cancer without losing recurrence-free survival (Tie 2022). Escalation remains unproven and about 10% of ctDNA-negative stage II patients still recur."],"principle":"Patient-specific variant panel designed from tumour sequencing, tracked at very high depth in plasma.","strengths":["Months of lead time over imaging","Enables escalation and de-escalation trials"],"limitations":["Sensitivity limited by cfDNA quantity","Lead time without proven intervention causes anxiety"]},"route":"/technologies/mrd-testing/","neighbours":{"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"},{"id":"colorectal-roadmap","kind":"roadmap","name":"Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation","route":"/roadmaps/colorectal-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/"},{"id":"diagnostics-roadmap","kind":"roadmap","name":"Diagnostics roadmap: stains → gene panels → blood tests that decide treatment","route":"/roadmaps/diagnostics-roadmap/"},{"id":"gallbladder-cancer-roadmap","kind":"roadmap","name":"Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials","route":"/roadmaps/gallbladder-cancer-roadmap/"},{"id":"cure-paths","kind":"roadmap","name":"Paths to cures: interception, eradication, control","route":"/roadmaps/cure-paths/"},{"id":"surgery-roadmap","kind":"roadmap","name":"Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work","route":"/roadmaps/surgery-roadmap/"},{"id":"tnbc-history","kind":"roadmap","name":"TNBC roadmap: from 'nothing to target' to ADC + immunotherapy first line","route":"/roadmaps/tnbc-history/"},{"id":"trial-modernisation-roadmap","kind":"roadmap","name":"Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on","route":"/roadmaps/trial-modernisation-roadmap/"},{"id":"tnbc-roadmap","kind":"roadmap","name":"Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem","route":"/roadmaps/tnbc-roadmap/"},{"id":"virtual-cell","kind":"roadmap","name":"Virtual cell roadmap: from bulk omics to a predictive model of a cancer cell","route":"/roadmaps/virtual-cell/"}],"idea":[{"id":"idea-bio1-ctdna-clone-report","kind":"idea","name":"A clone report from blood at every treatment cycle","route":"/ideas/idea-bio1-ctdna-clone-report/"},{"id":"idea-gbc-ctdna-residual-disease-guided-adjuvant-trial","kind":"idea","name":"A ctDNA residual disease-guided adjuvant trial after gallbladder cancer resection","route":"/ideas/idea-gbc-ctdna-residual-disease-guided-adjuvant-trial/"},{"id":"idea-bio2-mrd-clinic-service","kind":"idea","name":"A dedicated clinic for people whose blood test says the cancer is back","route":"/ideas/idea-bio2-mrd-clinic-service/"},{"id":"idea-fund-biomarker-validation-fund","kind":"idea","name":"A fund for prospective validation of academic biomarkers and companion diagnostics","route":"/ideas/idea-fund-biomarker-validation-fund/"},{"id":"idea-bio2-national-mrd-platform","kind":"idea","name":"A national platform trial that every ctDNA-positive patient can join","route":"/ideas/idea-bio2-national-mrd-platform/"},{"id":"idea-moon-mrd-weather-service","kind":"idea","name":"A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled","route":"/ideas/idea-moon-mrd-weather-service/"},{"id":"idea-fund-metastasis-moonshot","kind":"idea","name":"A ring-fenced metastasis programme with metastasis-specific endpoints","route":"/ideas/idea-fund-metastasis-moonshot/"},{"id":"idea-bio2-oligometastatic-signature","kind":"idea","name":"A test to tell true oligometastatic disease from hidden widespread spread","route":"/ideas/idea-bio2-oligometastatic-signature/"},{"id":"idea-bio2-survivor-plasma-biobank","kind":"idea","name":"Bank yearly blood from cancer survivors so future tests can be validated","route":"/ideas/idea-bio2-survivor-plasma-biobank/"},{"id":"idea-adjuvant-selection-rcc","kind":"idea","name":"Biomarker-selected adjuvant therapy in RCC (ctDNA, CAIX PET, gene signatures)","route":"/ideas/idea-adjuvant-selection-rcc/"},{"id":"idea-bladder-preservation-mibc","kind":"idea","name":"Bladder preservation for MIBC after perioperative EV + pembrolizumab complete response","route":"/ideas/idea-bladder-preservation-mibc/"},{"id":"idea-bio2-autophagy-block-mrd","kind":"idea","name":"Block the recycling that keeps dormant cells alive","route":"/ideas/idea-bio2-autophagy-block-mrd/"},{"id":"idea-bio2-il1-awakening-blockade","kind":"idea","name":"Blunt the inflammation that wakes sleeping cancer cells","route":"/ideas/idea-bio2-il1-awakening-blockade/"},{"id":"idea-bio2-net-blockade-perioperative","kind":"idea","name":"Break the neutrophil DNA nets that catch tumour cells after surgery","route":"/ideas/idea-bio2-net-blockade-perioperative/"},{"id":"idea-tr2-ctdna-reference-plasma","kind":"idea","name":"Certified reference samples to benchmark every tumour-DNA blood test","route":"/ideas/idea-tr2-ctdna-reference-plasma/"},{"id":"idea-bio2-perioperative-betablocker-nsaid","kind":"idea","name":"Cheap perioperative beta-blocker plus anti-inflammatory to blunt surgical stress","route":"/ideas/idea-bio2-perioperative-betablocker-nsaid/"},{"id":"idea-bio2-ctc-clearance-go-nogo","kind":"idea","name":"Circulating tumour cell clearance as the phase 2 gate for anti-metastatic drugs","route":"/ideas/idea-bio2-ctc-clearance-go-nogo/"},{"id":"idea-tnbc-ctdna-guided-adjuvant-decisions","kind":"idea","name":"ctDNA-guided adjuvant decisions after residual disease: escalate the positive, spare the negative","route":"/ideas/idea-tnbc-ctdna-guided-adjuvant-decisions/"},{"id":"idea-ctdna-guided-adjuvant-crc","kind":"idea","name":"ctDNA-guided adjuvant therapy as the default in stage II-III colon cancer","route":"/ideas/idea-ctdna-guided-adjuvant-crc/"},{"id":"idea-ctdna-guided-adjuvant-melanoma","kind":"idea","name":"ctDNA-guided adjuvant therapy in stage II-III melanoma","route":"/ideas/idea-ctdna-guided-adjuvant-melanoma/"},{"id":"idea-ctdna-guided-parp-duration","kind":"idea","name":"ctDNA-guided duration of PARP maintenance","route":"/ideas/idea-ctdna-guided-parp-duration/"},{"id":"idea-ctdna-escalation-tnbc","kind":"idea","name":"ctDNA-triggered escalation in early TNBC","route":"/ideas/idea-ctdna-escalation-tnbc/"},{"id":"idea-crc-peritoneal-disease-found-early-and-treated-in-networks","kind":"idea","name":"Find peritoneal spread while it is still small, and run complete cytoreduction through networks rather than adding heated chemotherapy","route":"/ideas/idea-crc-peritoneal-disease-found-early-and-treated-in-networks/"},{"id":"idea-bio2-cxcr4-mobilise-then-kill","kind":"idea","name":"Flush dormant cells out of bone marrow, then kill them","route":"/ideas/idea-bio2-cxcr4-mobilise-then-kill/"},{"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/"},{"id":"idea-hpv-ctdna-cervical","kind":"idea","name":"HPV circulating tumour DNA to guide cervical cancer therapy","route":"/ideas/idea-hpv-ctdna-cervical/"},{"id":"idea-late-recurrence-interception","kind":"idea","name":"Intercepting late recurrence with ctDNA surveillance and oral SERDs","route":"/ideas/idea-late-recurrence-interception/"},{"id":"idea-bio2-pro-dormancy-therapy","kind":"idea","name":"Keep dormant cells asleep instead of trying to kill them","route":"/ideas/idea-bio2-pro-dormancy-therapy/"},{"id":"idea-dormancy-maintenance-therapy","kind":"idea","name":"Keep them asleep: dormancy maintenance as adjuvant therapy","route":"/ideas/idea-dormancy-maintenance-therapy/"},{"id":"idea-moon-metastasis-prevention-indication","kind":"idea","name":"Metastasis prevention as a formal indication with its own trials and regulatory pathway","route":"/ideas/idea-moon-metastasis-prevention-indication/"},{"id":"idea-mrd-guided-stop-myeloma","kind":"idea","name":"MRD-guided treatment-free intervals in myeloma","route":"/ideas/idea-mrd-guided-stop-myeloma/"},{"id":"idea-shared-kras-vaccine-adjuvant","kind":"idea","name":"Off-the-shelf KRAS vaccines after pancreatic cancer 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positive","route":"/ideas/idea-bio2-mrd-triggered-neoantigen-vaccine/"},{"id":"idea-bio1-adaptive-car-antigen-switch","kind":"idea","name":"Plan the second CAR-T target before the first one is lost","route":"/ideas/idea-bio1-adaptive-car-antigen-switch/"},{"id":"idea-bio2-whole-genome-mrd-depth","kind":"idea","name":"Push residual disease detection a hundredfold deeper with whole-genome methods","route":"/ideas/idea-bio2-whole-genome-mrd-depth/"},{"id":"idea-pdac-ras-inhibitor-combinations-and-sequencing","kind":"idea","name":"RAS inhibitor combinations and sequence: pan-RAS plus G12D-selective, plus chemotherapy, and what to give after progression","route":"/ideas/idea-pdac-ras-inhibitor-combinations-and-sequencing/"},{"id":"idea-ras-inhibitor-neoadjuvant-pdac","kind":"idea","name":"RAS(ON) inhibitors to convert unresectable pancreatic cancer to resectable","route":"/ideas/idea-ras-inhibitor-neoadjuvant-pdac/"},{"id":"idea-bio2-csf-ctdna-monitoring","kind":"idea","name":"Read the spinal fluid to track brain tumours without opening the skull","route":"/ideas/idea-bio2-csf-ctdna-monitoring/"},{"id":"idea-bio2-mrd-reference-standards","kind":"idea","name":"Reference materials and open proficiency testing for residual disease tests","route":"/ideas/idea-bio2-mrd-reference-standards/"},{"id":"idea-bio2-platelet-cloak-aspirin-mrd","kind":"idea","name":"Strip the platelet coat off travelling tumour cells in ctDNA-positive patients","route":"/ideas/idea-bio2-platelet-cloak-aspirin-mrd/"},{"id":"idea-crc-ctdna-de-escalation-beyond-stage-ii","kind":"idea","name":"Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps","route":"/ideas/idea-crc-ctdna-de-escalation-beyond-stage-ii/"},{"id":"idea-bio2-circadian-mrd-sampling","kind":"idea","name":"Take the blood test, and give the drug, at the right time of day","route":"/ideas/idea-bio2-circadian-mrd-sampling/"},{"id":"idea-bio2-sonobiopsy","kind":"idea","name":"Ultrasound-assisted blood test instead of a brain biopsy","route":"/ideas/idea-bio2-sonobiopsy/"},{"id":"idea-urine-ctdna-surveillance","kind":"idea","name":"Urine tumour DNA to replace surveillance cystoscopy in NMIBC","route":"/ideas/idea-urine-ctdna-surveillance/"},{"id":"idea-bio2-ctdna-six-week-io-switch","kind":"idea","name":"Use a blood test at six weeks to decide whether to keep going","route":"/ideas/idea-bio2-ctdna-six-week-io-switch/"},{"id":"idea-bio2-mrd-guided-endocrine-duration","kind":"idea","name":"Use residual disease tests to decide who needs ten years of hormone therapy","route":"/ideas/idea-bio2-mrd-guided-endocrine-duration/"},{"id":"idea-tr1-ctdna-guided-stop-in-metastatic-disease","kind":"idea","name":"Use tumour DNA in blood to decide when to pause treatment in metastatic cancer","route":"/ideas/idea-tr1-ctdna-guided-stop-in-metastatic-disease/"},{"id":"idea-dtc-colonisation-determinants","kind":"idea","name":"What decides which disseminated cells ever colonise?","route":"/ideas/idea-dtc-colonisation-determinants/"},{"id":"idea-bio2-localise-the-mrd","kind":"idea","name":"When the blood test is positive, hunt for the lesion with sensitive imaging","route":"/ideas/idea-bio2-localise-the-mrd/"}],"cancer":[{"id":"urothelial","kind":"cancer","name":"Bladder & urothelial cancer","route":"/cancers/urothelial/"},{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"},{"id":"cml","kind":"cancer","name":"Chronic myeloid leukaemia (CML)","route":"/cancers/cml/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"early-cervical-cancer","kind":"cancer","name":"Early cervical cancer and fertility-sparing surgery","route":"/cancers/early-cervical-cancer/"},{"id":"early-gastric-cancer","kind":"cancer","name":"Early gastric cancer","route":"/cancers/early-gastric-cancer/"},{"id":"hcc-early","kind":"cancer","name":"Early hepatocellular carcinoma (BCLC 0 and A)","route":"/cancers/hcc-early/"},{"id":"her2-positive-early-breast-cancer","kind":"cancer","name":"Early HER2-positive breast cancer","route":"/cancers/her2-positive-early-breast-cancer/"},{"id":"tnbc-early","kind":"cancer","name":"Early triple-negative breast cancer","route":"/cancers/tnbc-early/"},{"id":"egfr-mutant-nsclc","kind":"cancer","name":"EGFR-mutated non-small-cell lung cancer","route":"/cancers/egfr-mutant-nsclc/"},{"id":"endometrial","kind":"cancer","name":"Endometrial cancer","route":"/cancers/endometrial/"},{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"breast-her2-positive","kind":"cancer","name":"HER2-positive breast cancer","route":"/cancers/breast-her2-positive/"},{"id":"hr-positive-early-high-risk","kind":"cancer","name":"High-risk early HR-positive breast cancer","route":"/cancers/hr-positive-early-high-risk/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"inflammatory-breast-cancer","kind":"cancer","name":"Inflammatory breast cancer","route":"/cancers/inflammatory-breast-cancer/"},{"id":"locally-advanced-cervical-cancer","kind":"cancer","name":"Locally advanced cervical cancer","route":"/cancers/locally-advanced-cervical-cancer/"},{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"gastric-msi-high","kind":"cancer","name":"Microsatellite-unstable (MSI-high) gastric cancer","route":"/cancers/gastric-msi-high/"},{"id":"mixed-phenotype-acute-leukaemia","kind":"cancer","name":"Mixed-phenotype acute 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