ctDNA monitoring guides immunotherapy decisions in metastatic urothelial cancer

Experts discussed how circulating tumor DNA (ctDNA) testing is being used to follow patients with metastatic urothelial carcinoma and to help shape immunotherapy choices.

They noted that a rapid drop in ctDNA levels often mirrors a good clinical and radiographic response, whereas continued ctDNA positivity can signal resistance to current therapy.

The panel highlighted that ctDNA results can inform treatment de‑escalation, particularly for patients experiencing toxicity from combinations such as enfortumab vedotin plus pembrolizumab.

While ctDNA may reveal molecular recurrence earlier than imaging, clinicians cautioned that its sensitivity can be limited in certain settings.