Joshua Meeks, MD, on the emerging role of ctDNA in MIBC

In an interview at the2025 Society of Urology Oncology Annual Meeting in Phoenix, Arizona, Joshua J. Meeks, MD, PhD, sat down with Urology Times® to discuss the emerging role of circulating tumor DNA (ctDNA) in guiding adjuvant and neoadjuvant strategies in patients with bladder cancer.

Meeks is a professor of urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Meeks began by highlighting results from the phase 3 IMvigor-011 trial (NCT04660344), which demonstrated that ctDNA status could accurately predict which patients with muscle-invasive bladder cancer (MIBC) would benefit from adjuvant treatment with atezolizumab (Tecentriq).¹

“That data is pretty strong,” Meeks noted. “I think the challenge is that those are all chemotherapy-treated patients, and we're quickly getting to the point where our perioperative therapy is changing. For example, EV/pembro was [recently] approved. What do we do with the ctDNA there?”

Meeks also touched on the unknown role for ctDNA in guiding decisions about the need for cystectomy or trimodal therapy in the neoadjuvant space. He emphasized that the field is still far from confidently using biomarkers alone to guide these decisions, and he also emphasized caution in using ctDNA negativity to justify omitting cystectomy.

“You would want imaging to be very good. I still think there's an immeasurable role for the surgeon going in and doing an exam and doing a TURBT, seeing what the bladder looks like. [If] you put all those together—imaging and ctDNA and what the bladder looks like—then you can begin to have a risk-benefit discussion with the patient.”

REFERENCE

1. Powles T, Kann AG, Castellano D, et al. ctDNA-guided adjuvant atezolizumab in muscle-invasive bladder cancer. N Engl J Med. Published online October 20, 2025. Accessed October 20, 2025. doi:10.1056/NEJMoa2511885