Integrating Biomarkers and ctDNA Insights Into Future NMIBC Management

The expert faculty discuss the emerging role of circulating tumor DNA (ctDNA) and urinary tumor DNA (utDNA) as biomarkers in bladder cancer, exploring their prognostic and potentially predictive implications for non–muscle-invasive bladder cancer (NMIBC). They highlight that a subset of patients presents with ctDNA positivity despite no visible disease on imaging, suggesting occult systemic involvement. Data from trials such as IMvigor011 and CheckMate-274 demonstrate that ctDNA can help identify patients who may benefit from adjuvant immunotherapy, with persistently negative patients showing low recurrence risk. The panelists agree that while ctDNA and utDNA are not yet ready for routine use in NMIBC, they hold promise for refining patient selection and guiding early systemic intervention. They also caution that current assays lack perfect sensitivity and must complement—not replace—clinical evaluation and imaging. Overall, biomarker-driven treatment strategies represent an exciting frontier in advancing personalized NMIBC care.