New data from Natera has demonstrated its Signatera molecular residual disease (MRD) test’s role in determining which resected colorectal liver metastases (CRLM) patients may benefit from adjuvant chemotherapy (ACT).
Signatera is designed to detect circulating tumour DNA to identify microscopic cancer remnants post-surgery, to track treatment response and predict recurrence. Circulating tumour DNA is tiny fragments that are shed by cancer cells into a patient’s bloodstream.
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Published in JAMA Oncology, Natera’s study included 298 patients from the GALAXY trial, the prospective, observational arm of CIRCULATE-Japan. The study’s outcomes were evaluated according to MRD status and whether patients received ACT, with a median follow-up of 43 months.
While MRD status has previously been shown to predict a disease-free survival (DFS) benefit from ACT, Natera highlighted that it had not shown benefit for overall survival (OS). According to the Texas-based company, data from its GALAXY trial arm represents the first dataset in a large cohort to show MRD test prediction of OS from ACT in this population.
Among MRD-positive patients who underwent surgery without neoadjuvant chemotherapy, ACT was associated with improved OS compared to observation, with a 48-month OS of 65.3% versus 32.9%. Meanwhile, no survival benefit from ACT was observed in MRD-negative patients.
The study also indicated that post-surgical MRD status was strongly prognostic, with MRD positivity 2–10 weeks after surgery associated with significantly worse DFS and OS, including those who received neoadjuvant chemotherapy before surgery.
Dr Adham Jurdi, senior medical director of oncology at Natera, commented: “This analysis adds important overall survival data in resected colorectal liver metastases, a setting where clinicians have historically had limited tools to determine who is most likely to benefit from ACT. “It further reinforces how Signatera can help tailor treatment to each patient.”
Ahead of its publication in JAMA, the data was shared during an oral presentation at the 2026 European Society for Medical Oncology Gastrointestinal (ESMO GI) Congress, which took place 1-4 July in Munich, Germany.
“For patients with colorectal liver metastases, the benefit of ACT after curative-intent surgery has remained uncertain,” said Dr Kozo Kataoka, division of lower GI, department of gastroenterological surgery, Hyogo Medical University, and senior author of the study.
“Importantly, this is the largest analysis to show that post-surgical MRD status may help identify which patients benefit from ACT in patients who underwent upfront surgery,” Kataoka continued.
MRD testing is coming to be viewed as a significant tool in the precision oncology space. In April 2026, CareDX acquired Naveris, inheriting the Massachusetts-based company’s NavDX liquid biopsy platform for tumour‑naïve testing and patient management from diagnosis through post‑treatment MRD surveillance. Meanwhile, Roche subsidiary Foundation Medicine acquired Saga Diagnostics in a $595m buyout in April 2026, with the company’s CEO, Dan Malarek, touting MRD tests as “one of the fastest-growing areas within diagnostics”.
