Blog | 3/18/2026

MRD Testing in Solid Tumors: Are We Approaching a Tipping Point in Adoption?

By Gary Gustavsen, Earl Gillespie, PhD, Camden Carmichael, and Brandon Demkowicz

Minimal residual disease (MRD) testing has quickly become one of the most closely watched areas in oncology diagnostics. Advances in circulating tumor DNA (ctDNA) detection are enabling earlier, less invasive identification of disease dynamics for solid tumors, raising the possibility of intervening before relapse becomes clinically apparent.

While enthusiasm for MRD testing in solid tumors has built steadily over the past several years, the field now appears to be entering a more consequential phase. Technical capabilities are maturing, biopharma engagement is accelerating, and early clinical data are beginning to demonstrate tangible patient benefit. At the same time, meaningful barriers to adoption remain. In this blog, we examine the drivers and constraints shaping MRD testing adoption and assess whether the field is nearing a true inflection point. 

Defining MRD

Minimal residual disease refers to small amounts of cancer that persist after treatment and are typically undetectable using conventional imaging or clinical assessment. Most solid tumor MRD assays rely on ctDNA analysis from blood, offering a minimally invasive approach to longitudinal disease monitoring.

Across oncology, MRD is being explored in three primary clinical settings:

• Early‑stage landmark testing, where MRD status following therapy may inform neo-adjuvant and adjuvant treatment decisions
• Recurrence monitoring, using serial blood testing to detect molecular relapse months or even years before radiographic progression
• Advanced or metastatic disease monitoring, where ctDNA dynamics can act as a real‑time indicator of treatment response or emerging resistance

Figure 1: Overview of MRD Use Cases by Tumor Stage

Each use case differs in its clinical risk tolerance, evidence requirements, and economic implications, all contributing to the heterogeneous pace of adoption observed today.

Why MRD Testing Has Become a Strategic Priority for Diagnostics Companies

MRD testing has emerged as a near‑universal topic in discussions with both specialty labs and kit manufacturers. These players increasingly view MRD testing as a critical component of a comprehensive oncology testing portfolio, complementing tissue‑based diagnostics and therapy selection assays.

As a result, companies are pursuing MRD capabilities through internal development, acquisitions, and partnerships. The strategic objective extends beyond adding a single test; many players aim to support patients across the full cancer care continuum, from diagnosis through post‑treatment surveillance.

Importantly, despite growing competition, MRD testing remains early in its adoption curve for solid tumors. High‑prevalence cancers such as colorectal, breast, lung, and prostate cancer represent millions of potential patients that could benefit, suggesting substantial runway for growth in testing. New entrants with strong clinical relationships or established commercial infrastructure may still find meaningful opportunities to differentiate and scale. 

Biopharma Engagement as a Potential Inflection Point

The involvement of biopharma companies may ultimately determine how quickly MRD testing transitions from promise to practice. Drug developers are increasingly incorporating MRD testing into clinical development programs to identify high‑risk patients earlier, enrich trial populations, and explore molecular endpoints.

Recent randomized studies in solid tumors have demonstrated that intervening at the point of molecular relapse can extend progression‑free survival and improve quality of life, even as overall survival data continue to mature. These findings represent an important proof point: molecular signals can provide actionable information earlier than traditional clinical markers.

Multiple myeloma has emerged as a proving ground outside of solid tumors, with regulators signaling openness to MRD as a surrogate or co‑primary endpoint in certain contexts. Broader acceptance in solid tumors may follow as additional datasets read out.

Technology Advancements and the Sensitivity Arms Race

Technical sensitivity remains a critical determinant of MRD utility for solid tumors, particularly in early‑stage and recurrence‑monitoring settings where ctDNA levels may be extremely low. As a result, developers are pushing the limits of detection through tumor‑informed approaches, whole‑genome sequencing strategies, and advanced error‑suppression techniques.

Recent industry activity underscores how central sensitivity has become as a competitive differentiator in MRD testing for solid tumors. Natera's acquisition of Foresight Diagnostics is a prime example, reflecting a broader "sensitivity arms race" playing out across the space. Natera’s Signatera test is a market leader in MRD testing, and integrating Foresight's phased-variant and ultra-low detection technologies is poised to push the assay to the top of sensitivity benchmarks. The move speaks to both the rapid technical progress underway and the growing strategic importance of assay performance as MRD applications expand into earlier-stage disease and lower disease burden settings.

Figure 2: Limits of Detection (LODs) of Several Major MRD Tests

While continued improvements in sensitivity are essential, technology alone will not drive adoption. Clinical confidence hinges on demonstrating that acting on MRD testing results leads to better patient outcomes, a standard that requires rigorous, prospective evidence.

Guidelines, Reimbursement, and Remaining Barriers

Clinical guidelines and payer coverage remain key gating factors. Major guideline bodies such as NCCN increasingly recognize ctDNA as a prognostic marker in select solid tumors, but most have stopped short of endorsing MRD‑guided treatment decisions.

On the reimbursement front, early progress in recurrence monitoring suggests growing acceptance, particularly within Medicare. However, commercial payer coverage remains limited, reflecting continued demand for robust clinical utility data. Over the next one to two years, results from pivotal trials may catalyze guideline updates and broader payer confidence, accelerating adoption across clinical settings.

Conclusion

MRD testing in solid tumors appears to be approaching a critical inflection point. The scientific rationale is compelling; technical capabilities continue to advance, and stakeholder interest across diagnostics and biopharma is strong. Yet widespread adoption will depend on aligning sensitivity, clinical utility, guidelines, and reimbursement.

For diagnostics developers, biopharma companies, and investors alike, success will require more than technical excellence. Clear evidence‑generation strategies, thoughtful market access planning, and seamless integration into real‑world clinical workflows will be essential to unlocking MRD’s full potential. To learn more about MRD testing and the industry dynamics shaping its growth, reach out to our Precision Medicine and Diagnostics teams.