A medical oncologist at a Northeast Academic NCI Comprehensive Cancer Center discusses their utilization and understanding of MRD and ctDNA monitoring in patients with bladder, renal, and prostate cancers. Currently, they are most familiar with these technologies in bladder, and are most optimistic about post-surgical MRD as compared to ctDNA monitoring due to lack of data in the latter. They are most familiar with Natera for MRD testing, though they are open to changing vendors in the future based on who has the most promising data specific to the patient populations they treat. They have already adopted MRD as a tool to help risk-stratify patients and in cases when they are resistant to treatment suggestions, test results can help rationalize this oncologists recommendations.

A medical oncologist and internist at a Southwest Comprehensive Cancer Center discusses their use of MRD / ctDNA monitoring. They utilize these technologies most often in melanoma patients but expect there to be more uptake of these tests in other common cancers such as lung, CRC, breast, and prostate. A major hindrance to their recommendation of using these tests is around lack of clinical data and guideline inclusions, in which they imagine vendors who release reputable data the most quickly will see the most success in this market. They are most familiar with Guardant and Natera as vendors in this space and are decently satisfied with both providers. They mentioned time to market / both these companies being early movers were key to their success.

A radiation oncologist and internist at a South-Central Comprehensive Cancer Center speaks to their experiences with MRD and ctDNA monitoring. A skeptical user of these technologies, this expert has experienced false positive and negative results firsthand, inhibiting their trust in using these types of tests. They are most familiar with Signatera for MRD and monitoring, but they are open to potentially changing vendors in the future based on clinical data releases, FDA approvals, and guideline recommendations. They do not expect the market to be a winner-takes-all scenario, though they believe that there are advantages to tumor-informed tests. Though this individual does not readily use MRD or ctDNA monitoring on their patients, they are most familiar with it in CRC, and they expect that there could be increased applications in breast cancers and NSCLC as well as esophageal cancer in the future pending guideline recommendations.

A diagnostics executive at a top pharma company discusses their current explorations of MRD and ctDNA monitoring. They are most familiar with Natera and Guardant as vendors, and in the future, they expect tumor-agnostic testing will be favored for broader use. They also provided feedback on ArcherDx, C2I and Grail. While they see utility of these technologies most in CRC and lung cancers, they imagine that there is potential for use in other indications such as breast, prostate, and ovarian cancers. This stakeholder mentioned these technologies already support registrational cancer trials for both targeted and immuno-oncology therapies. They believe that clinician education will be key hurdle needed to drive adoption.

A medical oncologist at an integrated health network on the East Coast expects the health care industry to adopt both MRD and ctDNA monitoring in the near future. They currently use these technologies for NSCLC, CRC, and breast cancer, with some monitoring done for melanoma patients as well. Monitoring to inform maintenance therapy is a use case they have adopted. They imagine that other cancer types would benefit from these tests, including renal cancer, bladder cancers, and even some rare tumor types like tumors of the head and neck. They utilize Natera and Guardant and are satisfied with both vendors. They do not expect to change vendors anytime soon, and they also do not imagine that the MRD marketplace will be a “winner takes all” landscape. Customer service was cited as key vendor criteria, and care needs to be taken so test costs do not fall on patients.

A medical oncologist at a specialty cancer center discusses their current experiences with using monitoring and MRD tests for their patients. This medical oncologist is most familiar with ctDNA monitoring in NSCLC and CRC patients, as well as some patients with renal or bladder cancer. They expect their use of these technologies to increase in coming years, as they see utility in other cancer types such as breast and even pancreatic. Their current test of choice is Signatera, though they were once a Guardant user, having since found preferences for tumor-informed testing. They expect that increased payer coverage and stronger clinical utility data will expedite test implementation, as they themselves would double their test volumes if prices allowed for it.

A director in translational medicine at a large pharma company speaks about their understanding of the utility of MRD and monitoring. They favor ctDNA monitoring as having more use-cases today, assuming that the assays have high sensitivity and specificity. They work mostly with trials for lung cancer patients, but they expect that other solid tumor cancers will benefit from these technologies in the future, especially if approaches are tumor informed. A strong user of Natera and Foundation Medicine, this stakeholder does not expect to switch vendors in the near future. They hope to see more coverage of these technologies in coming years to help with wider adoptions of testing and note that high prices are a barrier to uptake.

A solid tumor diagnostics lead at a multinational pharmaceutical company discusses their opinions around MRD and monitoring across different cancer indications, with their optimism for these technologies focused on CRC. This stakeholder works at a company that conducts ctDNA testing across thousands of patients in clinical trials every year, and is familiar with the MRD offerings from vendors such as Foundation Medicine, Natera, Guardant, Personalis, NeoGenomics, Invitae, Inivita, and Grail. This stakeholder dives deeply into the pain points around sequencing tumors, outlines future trends around using WGS and methylation sequencing, and expresses a sentiment that the MRD/monitoring market will eventually be dominated by 1-2 key players.

A community hospital oncologist speaks about their current usage of MRD and monitoring technologies. Though they currently use these technologies in the NSCLC setting along with complementary technologies like imaging, they have very optimistic perspectives of the use of these technologies for breast cancer, CRC, prostate, and renal cancers in the future. While reimbursement and coverage may be considered a pain point in the adoption of more advanced testing, this stakeholder notes that payers are fairly cooperative with covering tests that occur <2x a year from their current vendors. This oncologist is familiar with multiple vendors but primarily uses Caris, and they expect the MRD and monitoring landscape to have opportunities for multiple players to succeed. They have already started exploring post adjuvant concordance with post-adjuvant PET scans as a form of internal validation.

A director of translational oncology at a major global pharmaceutical company is familiar with MRD and monitoring for a variety of cancer applications, but is more optimistic about the utility of longitudinal monitoring compared to MRD. In addition to utility of this technology in lung, breast, CRC, bladder, and melanoma, this stakeholder expects renal cancer patients to benefit in the future as well. They are familiar with a variety of competitors in the space including Guardant, Natera, Invitae, and Foundation Medicine, though they expect the market to be dominated by only a few major players in upcoming years. These tools already play a key role in solid tumor clinical trials, but highlights cost limits the scale of experiments today, especially for serial testing.

A medical oncologist at a Southwestern AMC speaks about MRD and monitoring usage and trends for melanoma, breast cancer, colorectal cancer, bladder cancer, and lung cancer. Additionally, they speak to implementation of MRD for hepatocellular cancers. This stakeholder is most familiar with Guardant and Natera tests for MRD. They have an optimistic expectation for the adoption of MRD, specifically for CRC applications, and for monitoring in NSCLC and CRC populations, with the caveat that guidelines will be crucial to widespread adoption across the testing paradigm for all cancer types. Speaking to the landscape of competitors, this stakeholder values customer support and EMR integration, and envisions that the future of MRD and monitoring test selection will be dictated by patient’s preferences in addition to the physician’s vendor knowledge.