Introduction
Minimal residual disease (MRD) testing—using circulating tumor DNA (ctDNA) to detect minute traces of cancer after treatment—is generating increased interest in the management of solid tumors. As technology advances and more is understood about the potential of MRD assays, oncologists and payors alike are closely watching the evidence landscape for indicators of clinical benefit and practical value.
The Evolving Role of MRD Testing
At its core, MRD testing aims to reveal hidden cancer cells that remain in the body following treatment. The technology leverages sensitive molecular techniques to detect ctDNA in the blood, opening possibilities for earlier recurrence detection, improved risk assessment, and more tailored therapy. MRD applications span several phases of cancer care, including:
- Post-surgical (adjuvant) risk stratification
- Recurrence surveillance
- Monitoring response to treatment
- Guiding the intensity or duration of therapy
Recent years have seen MRD evaluated in an expanding array of solid tumor types and care settings. Its promise lies in the possibility of shifting from purely probability-based risk to individualized, biology-driven decision-making.
Clinical Promise & Evidence Gaps
MRD testing has drawn attention for its ability to signal increased risk of recurrence or treatment response trends earlier than some established clinical or imaging benchmarks. For certain cancer types, ctDNA can be detected well before conventional signs of relapse emerge, which—conceptually—could allow for timelier or data-driven interventions.
Yet, despite its strong theoretical and technical potential, MRD testing for solid tumors remains an area of active research and debate. The clinical community continues to seek definitive proof that changing management based on MRD testing directly improves patient outcomes, such as overall survival or quality of life, beyond what is achievable with current standard care. Ongoing and future studies will be critical to clarifying where the true value of MRD testing lies.
Payor and Guideline Perspectives
The excitement around MRD testing is tempered by a cautious stance among both professional organizations and payors. While experts acknowledge its prognostic value and innovation, consensus guidelines do not recommend routine MRD testing to guide treatment decisions outside of clinical trials. Coverage remains limited, most often restricted to research contexts or, in some cases, select scenarios with strict requirements.
Further real-world data, robust prospective trials, and clearer demonstration of clinical utility will be required before MRD testing can achieve widespread adoption and reimbursement. Stakeholders broadly agree: the opportunity is significant, but the bar for evidence is high.
The Path Forward
MRD testing holds the potential to radically personalize cancer care. However, it is critical for the oncology community to balance enthusiasm for novel approaches with deliberation over clinical benefit, workflow integration, and coverage policy. As more data emerge, greater clarity will follow regarding where and how MRD may best serve patients with solid tumors.
Rick Nida is the Founder and CEO of Market Access 360 Insights (MA360i) that is transforming diagnostics commercialization and market access by empowering innovative diagnostic labs to get paid for their breakthroughs with AI tools. He has authored multiple analyses on emerging cancer diagnostics and biomarker coverage in the U.S. payer landscape.
This article draws directly from the MA360i 2025 clinical evidence report and “Current Evidence & Future Outlook” infographic on MRD testing in solid tumors.
https://ma360i.com/evidence-assessment-coverage-implications/
Infographic summarizing key findings: https://ma360i.com/download-mrd-testing-infographic/