With therapies like Enfortumab Vedotin + Pembrolizumab (EVPembro) inducing a pathological complete response (PathCR) in 60% of patients, many undergo radical cystectomies only to find no residual cancer. This success rate is driving trials for bladder-sparing approaches like active surveillance.
A positive ctDNA (blood) but negative utDNA (urine) test suggests systemic, metastatic disease. Conversely, a positive utDNA with negative ctDNA points to a tumor confined to the bladder. This integrated biomarker approach can help determine whether systemic therapy or local treatment like surgery is the priority.
In bladder preservation strategies, circulating tumor DNA (ctDNA) from blood is poor at detecting non-muscle invasive local recurrences. This limitation makes urine tumor DNA (utDNA) a necessary future tool for monitoring patients under active surveillance, potentially replacing invasive cystoscopies.
Circulating tumor DNA (ctDNA) identifies post-surgery patients at high risk of relapse. By targeting adjuvant immunotherapy to only this ctDNA-positive group, previously negative clinical trials demonstrate a significant survival benefit. This approach spares low-risk, ctDNA-negative patients from unnecessary treatment and toxicity.