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ctDNA Dynamics and Recurrence Patterns after Organ-Sparing Trimodality Therapy for Bladder Cancer.

Ilana B Epstein1, Adetolani Odogiyon2, Stephanie Berg1

  • 1Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.

Clinical Cancer Research : an Official Journal of the American Association for Cancer Research
|January 26, 2026
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Summary
This summary is machine-generated.

Plasma circulating tumor DNA (ctDNA) can predict metastatic recurrence in muscle-invasive bladder cancer (MIBC) patients treated with trimodality therapy (TMT). However, ctDNA is not associated with local disease recurrence after TMT for MIBC.

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Area of Science:

  • Oncology
  • Molecular Diagnostics

Background:

  • Muscle-invasive bladder cancer (MIBC) is a significant health concern.
  • Trimodality therapy (TMT) offers a bladder-sparing alternative to cystectomy for MIBC.
  • Plasma circulating tumor DNA (ctDNA) shows promise in monitoring treatment response but its role in TMT for MIBC is not well-defined.

Purpose of the Study:

  • To investigate the association between plasma ctDNA and clinical outcomes in patients with MIBC undergoing TMT.
  • To determine if ctDNA can predict metastatic versus local recurrence after TMT for MIBC.

Main Methods:

  • Prospective study of 84 MIBC patients treated with TMT at two major cancer centers.
  • ctDNA analysis using the Signatera™ assay at baseline and post-treatment.
  • Correlation of ctDNA status with clinical disease status, including metastatic and local recurrence.

Main Results:

  • 19% of patients had detectable ctDNA at baseline before chemoradiotherapy (CRT).
  • Detectable ctDNA post-CRT strongly correlated with metastatic recurrence (p<0.0001).
  • No association was found between post-TMT ctDNA and local bladder recurrence.

Conclusions:

  • Plasma ctDNA is a valuable biomarker for predicting metastatic recurrence in MIBC patients treated with TMT.
  • ctDNA detectability after TMT is not indicative of local disease recurrence.
  • Further research can explore integrating ctDNA monitoring into TMT surveillance protocols for MIBC.