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Medical Tests

Gastrointestinal Cancers

Personalized MRD Testing

Signatera for Colorectal Cancer

Signatera is redefining the standard for MRD assessment through personalized, tumor-informed molecular testing.

By custom-designing each assay to a patient's unique cancer signature, Signatera identifies colorectal cancer recurrence with high sensitivity, detecting molecular relapse months ahead of traditional imaging. This window of lead time empowers clinicians to intervene earlier, optimize adjuvant therapy, and make more confident treatment decisions.

Covered by Medicare for CRC in adjuvant and recurrence monitoring settings
Clinical value cards for Signatera colorectal cancer testing
8.7 Months average lead time of ctDNA detection before CT scan4
97% 36-month OS in ctDNA-negative patients1

MRD Assessment

Redefining the standard through personalized, tumor-informed molecular testing

Signatera identifies colorectal cancer recurrence with high sensitivity by tracking patient-specific tumor variants over time.

That molecular view can support treatment planning across early and late stage CRC, helping care teams interpret recurrence risk, therapy response, and surveillance signals with greater confidence.

All stages MRD window chart

Inform Clinical Challenges

Clinical evidence in colorectal cancer

Signatera MRD status can provide clinically meaningful insight into survival and recurrence risk.

Predict overall survival 97%

of ctDNA-negative patients vs. 71.8% of ctDNA-positive patients had 36-month OS.1

ctDNA clearance and survival 100%

ctDNA-positive patients who achieved sustained clearance had 100% OS at 24 months.1

Overall survival by MRD status chart

Treatment Escalation

Predict which CRC patients may benefit from treatment escalation

CALGB (Alliance)/SWOG 80702 publication JAMA Oncology evaluated the predictive and prognostic value of Signatera in 940 stage III colon cancer treated with adjuvant FOLFOX ± celecoxib.

Signatera-positive patients treated with both chemotherapy and celecoxib showed a 40% improvement in overall survival compared to chemotherapy alone.2

No benefit from celecoxib was observed in Signatera-negative patients.

Celecoxib improved DFS in Signatera-positive patients, independent of PIK3CA mutational status.

Stage III colorectal cancer treatment escalation chart

Natera Cancer Care

Support therapy recommendations with MRD and tumor genomic profiling

Altera tumor genomic profiling for patient selection + Signatera MRD testing. Altera detects PI3K pathway mutations (PIK3CA, PTEN, PIK3R1), which guide NSAID therapy decisions.

With a single sample, you can get molecular residual disease (MRD) and tumor genomic profiling from the same tumor sample, enabling selection of the right patients for additional therapy and tracking MRD status over time.

Metastasis-directed therapy Signatera chart

Metastasis-Directed Therapy

Signatera-positive status predicted MDT better than CEA

Signatera identified more patients eligible for curative-intent MDT during surveillance by detecting recurrence at the molecular level, when patients are still candidates for local therapy.3

ctDNA clearance over time chart
Average lead time card for ctDNA detection before CT scan

Clinical Applications

Clinical applications for Signatera in CRC

Medically actionable information can guide treatment decisions from diagnosis through survivorship.

Clinical applications pathway for Signatera in colorectal cancer
01

Neoadjuvant response monitoring

Monitor neoadjuvant response with serial Signatera testing. Identify low-risk patients who are ctDNA-negative to potentially support a nonsurgical watch and wait approach.

02

Post-surgical MRD assessment

Identify patients at high risk of recurrence who may benefit from adjuvant chemotherapy.

03

Recurrence monitoring

Assess MRD more accurately than current risk assessment methods. ctDNA-positivity in the surveillance window was predictive of inferior DFS.

Serial Testing

What is the value of serial testing in surveillance?

Compared to patients who were serially ctDNA-negative, patients with ctDNA positivity at any timepoint were approximately 34 times more likely to recur (HR: 33.56, 95% CI: 26.07-43.20, P < 0.0001).1

Serial monitoring can help clinicians evaluate neoadjuvant response, post-surgical MRD status, and recurrence risk across the patient journey.

Serial surveillance pathway graphic

Coverage

Covered by Medicare for multiple solid tumor indications

Stage II-IV and oligometastatic colorectal cancer (CRC) in the adjuvant and recurrence monitoring settings

Stage II-IV breast cancer in the neoadjuvant setting, regardless of subtype, and Stage IIb and higher breast cancer in the adjuvant and recurrence monitoring settings

Muscle invasive bladder cancer (MIBC) in the adjuvant and recurrence monitoring settings

Stage I-III non-small cell lung cancer (NSCLC) in the surveillance setting

Stage II-IV ovarian, fallopian tube, or primary peritoneal cancer in the adjuvant and recurrence monitoring settings

Monitoring response to immune-checkpoint inhibitor (ICI) therapy for patients with any solid tumor

Advance Medilinks Support

Is Signatera for gastrointestinal cancer right for your patients?

Our team can help coordinate access, logistics guidance, and patient support for advanced cancer genomic testing.

References
  1. Nakamura Y, Watanabe J, Akazawa N, et al. ctDNA-based molecular residual disease and survival in resectable colorectal cancer. Nature Medicine. 2024.
  2. Zhang GQ, Meyerhardt JA, Shi Q, et al. Predictive Role of Circulating Tumor DNA in Stage III Colon Cancer Treated with Celecoxib: Findings from CALGB (Alliance)/SWOG 80702. JAMA Oncology. 2025.
  3. Dasari A, et al. Clinical utility of including circulating tumor DNA monitoring in standard of care colorectal cancer surveillance. Presented at ESMO Gastrointestinal Cancer Annual Meeting, 2025.
  4. Reinert T, et al. Analysis of plasma cell-free DNA by ultradeep sequencing in patients with stages I to III colorectal cancer. JAMA Oncology. 2019;5(8):1124-1131. DOI: 10.1001/jamaoncol.2019.0528.
  5. Kotani D, et al. Molecular residual disease and efficacy of adjuvant chemotherapy in patients with colorectal cancer. Nature Medicine. 2023;29(1).
  6. Nakamura Y, Reiter JG, Natarajan P, et al. Validation of a methylation-based tissue-free MRD assay in colorectal cancer patients from the GALAXY study. npj Precision Oncology. 2026. https://doi.org/10.1038/s41698-026-01277-5.

Our Services

Signatera™ Initial

Signatera™ Initial

Transforming the management of cancer with personalized testing Signatera™ is a highly sensitive and personalized molecular residual disease assay (MRD) using circulating tumor DNA (ctDNA), custom designed for...

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