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Overview
Natera, based in Austin and listed as NTRA, makes Signatera, the dominant tumour-informed test for measurable residual disease. Signatera has been run more than a million times and was used in the IMvigor011 trial that led to the first circulating tumour DNA-guided drug approval; the company also sells Altera for tumour profiling, Prospera for transplant monitoring and Panorama for prenatal testing. OnCo links it to colorectal cancer, to liquid biopsy, ctDNA monitoring and MRD testing, to bottlenecks on dormant cells and tumour heterogeneity, and to ideas on using tumour DNA to pause treatment in metastatic cancer and to stop combination arms early. Whether acting on a positive MRD result improves outcomes, rather than only predicting them, is the question the field now has to answer. Signatera has its own page.
Headquarters
Austin, TX, US
Scorecard
All companies#327of 1244 companies, score 12
- modalities +2
- 24-month regulatory events +2
- registry trials +8
0 approved, 0 in phase 3, 0 earlier, 0 targets, 15 registry studies. Formula on the scorecards page.
Type
Diagnostics · NTRA
Stage
Public
Website
EstablishedTumour-informed ctDNA MRD test
Signatera is Natera's tumour-informed blood test that tracks 16 mutations from each patient's own tumour to detect residual or returning cancer after surgery. Medicare covers it in colorectal, breast, bladder, lung and ovarian cancer and for immunotherapy monitoring, and in 2026 it selected the bladder cancer patients for the first approval based on circulating tumour DNA.
real worldESMO Gastrointestinal Oncology 20260 citations
Real-world analysis of ctDNA and other biomarkers in patients with curatively resected stage I-III biliary tract cancer
Together with the JCO Precision Oncology cohort this makes residual disease testing in biliary cancer prognostic to the same degree as in colon cancer. Nobody has yet shown that acting on it helps; that is the trial gap the ideas on this page name.
real worldJCO Precision Oncology 202518 citations
Detecting Early Recurrence With Circulating Tumor DNA in Stage I-III Biliary Tract Cancer After Curative Resection
Very wide confidence intervals from a small cohort, but the direction matches the larger 2026 analysis. Gallbladder cancer recurs early and distantly after re-resection, which is exactly the setting where a residual disease test could pick who gets more than capecitabine.
observationalNature Medicine 2023393 citations
GALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfold
The blood test stratifies risk far better than stage or pathology. It supports treating ctDNA-positive patients and suggests ctDNA-negative patients gain little from chemotherapy, but because treatment was not randomised the de-escalation claim needs the randomised trials that are now under way.
translationalAnnals of Oncology 2021384 citations
Circulating tumor DNA in neoadjuvant-treated breast cancer reflects response and survival
ctDNA clearance may refine pCR as a surrogate: a patient with residual disease but no ctDNA may not need escalation, the hypothesis behind ctDNA-guided post-neoadjuvant trials.
Similar pages
- CompanyGuardant Health
Shares An annual blinded shoot-out for liquid biopsy tests, Certified reference samples to benchmark every tumour-DNA blood test, Kill combination arms early using circulating tumour DNA, before waiting for scans, Reference materials and open proficiency testing for residual disease tests.
- CompanyForesight Diagnostics
Shares Consolidation of First-Line MRD+ Remission With Cema-cel in Patients With LBCL, Reference materials and open proficiency testing for residual disease tests, Continuous and near-continuous ctDNA monitoring, Dormant cells and minimal residual disease.
- IdeactDNA-guided adjuvant therapy as the default in stage II-III colon cancer
Shares GALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfold, Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps, Signatera, ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment.
- TermTumour-informed versus tumour-naive ctDNA assays
Shares BESPOKE CRC, Circulating tumor DNA in neoadjuvant-treated breast cancer reflects response and survival, CIRCULATE-US, GALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfold.
- TrialCIRCULATE-Japan (GALAXY / VEGA / ALTAIR)
Shares CIRCULATE-US, GALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfold, Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps, Signatera.
- IdeaA ctDNA residual disease-guided adjuvant trial after gallbladder cancer resection
Shares Detecting Early Recurrence With Circulating Tumor DNA in Stage I-III Biliary Tract Cancer After Curative Resection, Real-world analysis of ctDNA and other biomarkers in patients with curatively resected stage I-III biliary tract cancer, Signatera, ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment.
- Key paperDYNAMIC: a blood test safely halved chemotherapy use after surgery for stage II colon cancer
Shares GALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfold, Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps, Signatera, ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment.
- TrialALTAIR
Shares BESPOKE CRC, CIRCULATE-US, Signatera, MRD / molecular residual disease testing.
cancers
fronts
technologies
drugs
EstablishedTumour-informed ctDNA MRD test
trials
roadmaps
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 preservationctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment
ideas
An annual blinded shoot-out for liquid biopsy testsCertified reference samples to benchmark every tumour-DNA blood testKill combination arms early using circulating tumour DNA, before waiting for scansReference materials and open proficiency testing for residual disease testsTake ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helpsUse tumour DNA in blood to decide when to pause treatment in metastatic cancer
bottlenecks
key papers
Circulating tumor DNA in neoadjuvant-treated breast cancer reflects response and survivalDetecting Early Recurrence With Circulating Tumor DNA in Stage I-III Biliary Tract Cancer After Curative ResectionGALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfoldReal-world analysis of ctDNA and other biomarkers in patients with curatively resected stage I-III biliary tract cancer