NCCN updated its muscle-invasive bladder cancer guidance to include Natera’s Signatera ctDNA minimal residual disease testing. The guideline recommendation ties MRD status to Genentech’s Tecentriq (atezolizumab), stating that patients who are MRD-positive within one year after cystectomy should receive Tecentriq. The NCCN update specifies tumor-informed, PCR-based next-generation sequencing for circulating tumor DNA and notes that Signatera is the FDA-approved companion diagnostic for this indication. The inclusion follows results from the Phase III IMvigor011 trial, where patients ctDNA-positive by Signatera after cystectomy randomized to Tecentriq showed nearly doubled disease-free survival and significantly longer overall survival. Commercial coverage is expected to expand as guidelines shape payer policy, with the article citing Cigna coverage based on NCCN category recommendations and a stated addressable patient range.