Urothelial Cancer: Leveraging Circulating Tumor DNA To Avoid Unnecessary Bladder-directed and Systemic Therapies

Several studies have demonstrated the potential of circulating tumor DNA (ctDNA) for personalization of perioperative systemic treatment in muscle-invasive urothelial carcinoma (UC). Early studies focused on the ability to identify patients with residual disease who may benefit from additional systemic treatment. Further studies have suggested the potential of ctDNA measurement to tailor systemic and local treatments for patients with MIUC. This biomarker may ultimately reduce overtreatment, toxicity, and the financial burden associated with UC care. As ctDNA testing matures, it may offer clinicians a means to truly personalize treatment and thereby improve oncologic outcomes and enhance patients' quality of life. PATIENT SUMMARY: Our mini review looks at studies in which DNA from bladder cancer tumors that is circulating in the blood (called circulating tumor DNA, or ctDNA) is measured. Measurement of ctDNA levels after chemotherapy or immunotherapy can help predict cancer outcomes in patients undergoing bladder removal surgery.