The National Comprehensive Cancer Network updated muscle-invasive bladder cancer guidance to include Natera’s tumor-informed Signatera minimal residual disease test. Under the update, Genentech’s Tecentriq (atezolizumab) is recommended for patients who are MRD-positive within one year after cystectomy. The NCCN guidance specifies MRD testing requirements: FDA approval for the intended use, tumor-personalization, and PCR-based next-generation sequencing of circulating tumor DNA. Signatera’s inclusion is reinforced by its status as the only FDA-approved companion diagnostic for this specific indication. The change is anchored in Phase 3 IMvigor011 data, where Tecentriq improved disease-free survival and overall survival versus placebo among ctDNA-positive patients post-cystectomy with no radiographic disease. Commercially, analysts cited the guideline update as a potential driver of coverage and adoption—an important step for MRD as a risk-stratification category in oncology follow-up decision-making.