An international, multicenter study reported at ESMO and in associated publications that circulating tumor DNA (ctDNA) testing can stratify recurrence risk after surgery for muscle‑invasive bladder cancer and direct adjuvant immunotherapy. The biomarker‑guided approach identified patients with residual disease who benefitted from adjuvant therapy while sparing ctDNA‑negative patients from treatment and its toxicities. Investigators presented data from IMvigor011 and related studies showing ctDNA’s predictive value and utility in de‑escalation. The findings accelerate the clinical case for ctDNA as a decision tool in the adjuvant setting and will influence developers and payers considering companion diagnostics and trial designs.