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🚨 This could redefine how we manage resectable bladder cancer and oncology itself.

#IMvigor011 opens the era of MRD-guided adjuvant therapy (#ctDNA, #Signatera) in solid tumors.

The future is here: challenges, controversies & impact.
THREAD 🧵
@OncoAlert  #MRD #ESMO25 @OncoAlert 2/
Not new. In hematology, MRD has been the strongest predictor of relapse & survival for decades (ALL, AML, lymphomas).

It guides escalation & de-escalation 

What’s new: applying it to solid tumors with tumor-informed ctDNA

1. MSI-H/dMMR: the perfect storm for immunotherapy 🔥

▫️High TMB, tons of neoantigens, and inflamed tumors. Long-term survivors, even cures.
▫️Up to 40% still fail.

Cure or collapse, the paradox of MSI-H/dMMR 🧵⤵️
doi.org/10.1038/s41571… 2. The success story 📈

Metastatic Colorectal Cancer: Immunotherapy vs chemo
KEYNOTE-177 →↑ PFS, ORR ~45%, CR ~30%.
CheckMate-8HW → ORR ~70%, 2-yr PFS ~72%.

Localized CRC: NICHE-2 → 95% MPR, 67% pCR, 3-yr DFS 100% 😱

ICI achieves durable survival and, in some cases, cure.

One of oncology's paradoxes (🧵)
Testicular germ cell tumors cure >90% with cisplatin, one of medicine’s greatest triumphs.

But in mediastinal or extragonadal sites, survival drops to ~40–50%.

1. Why does one of the most curable cancers sometimes fail (~10-20%)?👇 2. Genetics
Testicular GCTs usually retain wild-type TP53 → intact apoptosis.

Extragonadal tumors often show TP53 mutations or MDM2 amplification, reducing cisplatin sensitivity.
ascopubs.org/doi/10.1200/JC…