From detection to direction: ctDNA-guided personalized therapy for muscle-invasive bladder cancer

Despite radical cystectomy, residual urothelial cancer cells can persist undetected in patients with muscle-invasive bladder cancer, silently seeding future relapse. New data from the phase III IMvigor011 trial demonstrate that circulating tumour DNA (ctDNA) can be used to effectively stratify patients by recurrence risk, enabling adjuvant atezolizumab to be delivered selectively to those who are likely to benefit. This precision ctDNA-guided strategy might fundamentally reshape postoperative management through alignment of treatment intensity with molecular risk.