INSIGHT. Cancer treatment has long focused on removing or destroying visible tumours, with limited ways to confirm whether all cancer cells were truly gone. Even after successful treatment, small numbers of cells can persist and later cause relapse. While liquid biopsy has been used in oncology for several years, recent advances in sensitivity are now enabling more regular monitoring over time through simple blood tests.
Minimal residual disease (MRD) refers to the very small amounts of cancer that remain after treatment. These cells are often undetectable with traditional methods and may not appear on imaging, yet studies show MRD status is closely linked to the risk of cancer relapse. Earlier detection enables more informed treatment decisions, and in some cases intervention before recurrence becomes detectable by conventional methods.
How MRD is measured
Not all MRD tests are equal. Some are tumour-informed, tracking mutations from a patient’s tumour, while others use broader approaches without requiring a tissue sample. Each has trade-offs in cost, speed, and applicability. Sensitivity is critical, as the signal in blood is extremely low.
Some newer methods that analyse structural DNA variations, rather than single mutations alone, have the potential to improve detection accuracy. Approaches like these can also enable more cost-efficient follow-up testing, making it possible to monitor patients more frequently over time.
A field gaining momentum
MRD is a rapidly growing area within precision diagnostics. Natera is among the leading players, and larger industry actors are moving in – Roche, for example, recently strengthened its position through Foundation Medicine’s agreement to acquire Saga Diagnostics.
As the field evolves, access to large, well-validated datasets is becoming a key competitive advantage, creating elements of a data-driven competitive dynamic.
Clinical and commercial potential
Beyond earlier detection, MRD testing is increasingly being used to guide treatment decisions – helping identify which patients may benefit from additional therapy and which may avoid it. This enables more targeted use of existing treatments rather than a one-size-fits-all approach. More precise treatment decisions can reduce unnecessary interventions, lower healthcare costs, and improve patient quality of life. As adoption increases, MRD is emerging as a key tool at the intersection of diagnostics and treatment – with the potential to reshape how cancer is both managed and studied.
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