Chauhan PS, Chen K, Babbra RK, et al. - Findings demonstrate a significant correlation between urine tumor DNA (utDNA) minimal residual disease (MRD) detection before curative-intent radical cystectomy for bladder cancer and pathologic response, which may aid selection of patients for bladder-sparing treatment. Noninvasive inference of tumor mutational burden (TMB) can be achieved using utDNA, resulting in facilitating personalized immunotherapy for bladder cancer in the future.

• Urine Cancer Personalized Profiling by Deep Sequencing was applied to urine cell-free DNA samples obtained on the day of curative-intent radical cystectomy from 42 localized bladder cancer patients.

• High correlation of positive utDNA MRD detection with the absence of pathologic complete response was found with a sensitivity of 81% and specificity of 81%.

• A significant correlation of utDNA MRD detection with progression-free survival (PFS) was also revealed.

• Significantly worse PFS was found in utDNA MRD–positive patients vs utDNA MRD–negative patients (HR = 7.4).

• Cases with high TMB inferred from urine might have been candidates for early therapy with immune checkpoint blockade.