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How Do We Translate MRD Innovation Into Everyday Oncology Practice?
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Released: December 15, 2025

John Marshall
John Marshall, MD
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How Do We Translate MRD Innovation Into Everyday Oncology Practice?

 

John Marshall, MD
John Marshall, Oncology Unscripted. I've talked about this a bunch on our program, and this is the impact of blood-based genetic testing on cancer care—maybe other health care problems as well. And the couple of ways we do blood-based testing: one is to look for mutations from a patient with a known cancer. But we're also using blood testing to see whether or not there is still cancer around—so-called minimal residual disease. And they're similar in technology but different in terms of how we're using them.

 

A lot of us out there are not using the MRD testing, whether it's tissue-based or not, because the truth is we don't really know what to do with that result. If it's negative, do I not give adjuvant chemotherapy? If it's positive, do I give more adjuvant chemotherapy? What if it flips? What if it doesn't? Et cetera. So there's a lot of unknowns, but there is this wave of data that continues to come out. San Antonio Breast coming up has new data around this. We've seen it at ASCO. We've seen newer publications more recently that suggest dramatic differences if your test is positive after surgery versus if it is negative, with hazard ratios that exceed 20. This is prediction of cancer still being around. And yes, the negatives are not perfect, but they, too, are pretty good.

 

So, we talk about finding the right patient to give treatment to in the adjuvant setting.I am certain that some sort of MRD testing is going to be part of this. And I was lucky enough to hear a fabulous lecture by a very, very good friend of mine, Dr Scott Kopetz from MD Anderson, who summarized the current data set around this and says that this is not going to go away. This is the inevitable. The question is: how are we, as health care providers, going to use this data to guide our patients, to guide our therapies, to improve efficiency around all kinds of therapy—most importantly, right now, adjuvant therapy?

 

So, review these data. Look at those hazard ratios. Decide whether or not you want to begin incorporating MRD testing into your general day-to-day care. And let's see what 2020 says with regards to treatment opportunities, clinical trials, et cetera, moving forward.

 

John Marshall for Oncology Unscripted.

 

This transcript has been lightly edited for clarity.