Natera, Inc. (NASDAQ:NTRA), a global leader in cell-free DNA and precision medicine, today announced the publication of new data in JAMA Oncology, evaluating the utility of Signatera, its personalized molecular residual disease (MRD) test, in patients with resected colorectal liver metastases (CRLM). The data was also presented as an oral presentation at the 2026 European Society for Medical Oncology Gastrointestinal (ESMO GI) Congress.

The liver is the most common site of distant metastasis in colorectal cancer, and CRLM is a major cause of cancer-related mortality.1,2 In patients where curative-intent surgery is possible, the benefit of adjuvant chemotherapy (ACT) has been a point of debate and uncertainty.3 MRD status has previously been shown to predict a disease free survival (DFS) benefit from ACT, but not an overall survival (OS) benefit. This is the first dataset in a large cohort to show MRD test prediction of OS from ACT in this population.

The JAMA paper included 298 patients from the GALAXY trial, the prospective, observational arm of CIRCULATE-Japan. Outcomes were evaluated according to MRD status and whether patients received ACT, with a median follow-up of 43 months. Key findings included:

  • Signatera identified patients who derive a significant survival benefit from ACT. Among MRD-positive patients who underwent surgery without neoadjuvant chemotherapy, ACT was associated with improved DFS and OS compared to observation (OS: adjusted HR, 0.27; P=0.03; 48-month OS, 65.3% vs. 32.9%; DFS: adjusted HR, 0.07; P<0.0001). MRD-negative patients had favorable outcomes, with no observed survival benefit from ACT.
  • Post-surgical MRD status was strongly prognostic. MRD positivity 2–10 weeks after surgery was associated with significantly worse DFS and OS, including those who received neoadjuvant chemotherapy before surgery (DFS: HR, 4.82; P<0.0001; OS: HR, 9.43; P<0.001), and those who did not (DFS: HR, 4.14; P<0.0001; OS: HR, 9.13; P<0.0001).