Minimal residual disease (MRD) testing advanced to clinical decision‑making in 2025 as Phase III and other randomized readouts validated ctDNA‑guided treatment strategies. The Phase III IMvigor011 trial used Natera’s Signatera tumor‑informed ctDNA assay to select muscle‑invasive bladder cancer patients for adjuvant atezolizumab, showing a statistically significant survival benefit for MRD‑positive patients receiving therapy. The randomized data underpinning Signatera’s utility strengthened the case for regulatory and guideline incorporation, spurring commercial consolidation in the MRD space and accelerating reimbursement discussions. Companies in the MRD ecosystem are preparing companion diagnostic submissions and scaling lab operations to meet anticipated clinical demand.