NCCN updated muscle-invasive bladder cancer guidance to include Natera’s Signatera ctDNA minimal residual disease test, supporting its use for risk stratification after cystectomy. The guideline recommends Tecentriq (atezolizumab) for patients who are MRD-positive within one year. The inclusion centers on results from the Phase 3 IMvigor011 trial, where MRD-positive patients randomized to Tecentriq showed disease-free survival of 9.9 months versus 4.8 months with placebo. Median overall survival was also longer with Tecentriq, 32.8 months versus 21.1 months. Analysts said the NCCN category support may improve commercial coverage for MRD testing, where reimbursement has been limited, and noted Signatera’s FDA companion diagnostic status for this indication.