Liquid Biopsy Newsletter
March 2026, Vol. 3
Dear Readers, dear Colleagues,
Two major publications this month sent a clear and consistent signal that shaped our thinking and approach at LIQOMICS.
First, a large-scale real-world study, published in Nature Medicine, analysed the cases of over 54,000 Japanese patients who underwent comprehensive genomic profiling (CGP). The findings are striking: despite 72.7% of patients carrying actionable mutations, only 8% received CGP-guided therapy to improve their outcome. While molecular profiling identifies what is there, it alone does not determine what to do about it or when.
Secondly, GRAIL's Galleri multi-cancer early detection test, which has long been heralded as a paradigm shift, has struggled to demonstrate a meaningful impact on patient outcomes in large-scale trials. Simply detecting a signal in the blood is not sufficient to change the course of cancer. The next steps remain unanswered by detection alone: which treatment, for how long, and what evidence will guide it.
These data do not diminish the value of cancer genomics or of the early detection provided by liquid biopsies. Rather, they highlight the key question: what type of liquid biopsy information actually influences clinical decisions and improves patient outcomes?
The answer is becoming clear: It is important to add longitudinal information, such as minimal residual disease (MRD). This month's newsletter focuses on a compelling example of this: the IMvigor011 trial in muscle-invasive bladder cancer (MIBC). For the first time in a solid tumour, a randomised phase III trial has demonstrated that using a liquid biopsy to detect circulating tumour DNA (ctDNA) for MRD testing can determine which patients require immunotherapy and which can be spared this treatment. This benefit is real, statistically significant, and clinically meaningful.
This is precisely the area in which LIQOMICS specialises. LymphoVista and CancerVista are more than just screening tools for genetic changes in cancer. They are instruments that guide therapy, providing real-time, non-invasive insights into tumour biology. This enables clinicians to personalise treatment, minimise unnecessary interventions, and protect patients from unnecessary therapies.
We believe that the IMvigor011 data will be a landmark and accelerate the adoption of ctDNA-MRD across oncology. You can find a rich evidence base for more than 20 cancer types at www.liquidbiopsyinfo.com.
We look forward to hearing your thoughts and continuing this conversation with you.
Warm regards,
Sven Borchmann MD, PHD, LIQOMICS founder and Managing Director
ctDNA-MRD Guides Treatment Decisions in Bladder Cancer: A Landmark Phase III Trial
Sven Borchmann MD, PHD, LIQOMICS explains the background and significance of IMvigor011. It is the first randomised trial to prove that circulating tumour DNA (ctDNA)-minimal residual disease (MRD) can inform treatment decisions in solid tumours.
What is Muscle-Invasive Bladder Cancer, and Why Does Treatment Guidance Matter?
Each year, muscle-invasive bladder cancer (MIBC) affects approximately 170,000 patients worldwide. Despite receiving curative treatment, a significant proportion of patients relapse within two years. For decades, it has not been possible to predict which patients will ultimately relapse after curative-intent chemotherapy and which will not. Clinicians have had no reliable way of identifying those who harbour residual microscopic disease and truly need adjuvant therapy.
Adjuvant immunotherapy with checkpoint inhibitors (ICIs) is effective for some patients, but giving it to all post-surgical patients would expose many to potential toxicity without any benefit and burden health care systems with unnecessary costs. The key clinical question is: who actually has remaining cancer cells after surgery, and who has already been cured?
The IMvigor011 Trial: A New Standard for MRD-Guided Treatment
IMvigor011 is a randomised, double-blind, placebo-controlled Phase III trial conducted by Genentech/Roche. The trial evaluated atezolizumab (Tecentriq) in patients with muscle-invasive bladder cancer (MIBC) who tested ctDNA-MRD-positive after radical cystectomy. The study addresses the key question of whether ctDNA-MRD status can identify patients who would benefit from adjuvant immunotherapy.
How the trial works:
- Patients with MIBC underwent radical cystectomy (curative surgical removal of the bladder)
- Post-surgery, all patients were tested with a validated ctDNA-MRD assay to assess MRD status
- Only ctDNA-MRD-positive patients were randomised: atezolizumab vs. placebo
- Primary endpoint: disease-free survival (DFS) in the MRD-positive population
The Study Data in Detail
| Parameter | Result | What does this mean? |
|---|---|---|
| Disease-Free Survival (DFS) Hazard Ratio (ctDNA-MRD positive, atezolizumab vs. placebo) | HR = 0.64 (p = 0.0047) | ctDNA-positive patients receiving atezolizumab had a 36% lower risk of disease recurrence or death: statistically significant and clinically meaningful |
| Median Overall Survival (ctDNA-MRD positive) | 29.8 vs. 14.1 months | Patients with detectable residual tumor DNA who received atezolizumab survived more than twice as long as those on placebo: the clearest measure of treatment benefit |
| Overall Survival at 24 months (ctDNA-MRD negative, no treatment) | 97.1% | Of 357 patients who were persistently ctDNA-negative and received no adjuvant therapy, 97.1% were still alive at 24 months, confirming that MRD-negative status reliably identifies patients who are effectively cured and can safely be spared treatment |
The Decisive Finding: MRD Status as the Treatment Switch
This is the core clinical insight from IMvigor011: ctDNA-MRD status after surgery cleanly separates patients who need further adjuvant treatment from those who do not. This is not a prognostic marker: it is a decision tool.
What does this mean in practice?
- ctDNA-MRD positive after surgery: Patient has residual microscopic disease. Adjuvant immunotherapy significantly improves survival.
- ctDNA-MRD negative after surgery: No detectable residual tumor DNA. Patient can safely avoid immunotherapy and all its associated risks and toxicities.
For patients and physicians: A simple blood draw replaces months of uncertainty and delivers a clear, actionable answer without waiting for clinical relapse.
The Broader Picture: What Truly Makes a Difference for Patients?
The differences between the Japan CGP study, the GRAIL experience and IMvigor011 are highly instructive. This is why IMvigor011 is important for more than just bladder cancer. It provides proof of concept that will transform oncology across tumour types. When liquid biopsy is only used to detect or profile, the clinical impact is limited. However, when it is used to inform treatment decisions, such as whether to start, continue, adapt or stop therapy, it can transform outcomes.
The IMvigor011 findings confirm what LIQOMICS already provides in clinical practice with LymphoVista and CancerVista: precise therapy guidance that answers specific clinical questions, such as whether treatment is still effective. Has the patient responded yet? Is there evidence of residual or recurrent disease? These answers help to reduce over-treatment, protect patients from unnecessary toxicity and support personalised care. LIQOMICS is a therapy guidance instrument that changes decisions and protects patients.
Sources:
- Saito Y et al. Real-world clinical utility of comprehensive genomic profiling in advanced solid tumors. Nature Medicine. 2026;32:690–701.
- Powles, Thomas, et al. "ctDNA-Guided Adjuvant Atezolizumab in Muscle-Invasive Bladder Cancer." N Engl J Med (2025).
- liquidbiopsyinfo.com: MRD evidence summary for MIBC and solid tumors: www.liquidbiopsyinfo.com
More Information: www.liqomics.com/cancervista | Personal consultation: contact@liqomics.com
