MRD 2.0: Deep Dive Into The Coming Solid Tumor Opportunity

A view of a blood sample under a microscope
Insight by , , , , , and

The TD Cowen Insight

Minimal residual disease (MRD) monitoring in solid tumors represents a >$20B TAM in the next 5 years across the top 4 cancers: colorectal, breast, lung, and bladder cancer. Our proprietary survey shows >50% order growth & increasing optimism that MRD tools support clinical decision-making. We also uncover surprisingly high use of MRD results to make treatment decisions, amplifying an already strong market opportunity in these four cancers. 

The Market Opportunity for MRD Monitoring in Solid Tumors

There is material enthusiasm regarding the market opportunity for minimal residual disease (MRD) monitoring in solid tumors spanning test providers, clinicians, KOLs, patients, and investors. The market remains in its infancy, though growth is ramping materially as medical adoption quickens. This is the case even ahead of broader guideline adoption and reimbursement. We are also enthusiastic about the commercial opportunity for MRD vendors.

Factors Driving TAM for MRD Monitoring In Solid Tumors

We currently estimate the TAM to be >$20B for the top 4 solid tumors alone. Additionally, according to our survey data, we expect material upside potential to the extent usage in stage 1 to occur. Factors driving this sizeable TAM include clinical utility, serial testing opportunities, from neoadjuvant (pre-surgical removal of the tumor) to adjuvant (post-surgery) all the way to surveillance settings. Other factors include strong Medicare coverage and reimbursement and anticipated guideline inclusion and commercial coverage expansion. 

Addressing Key Controversies and Debates

In our full report we address key controversies and debates surrounding MRD monitoring in solid tumors and tackle some pressing questions:

  • Per our diligence with a broad spectrum of oncologists we have come to better understand how their insights shed light on the question of whether the investor enthusiasm for MRD is fair or misplaced?
  • What type of MRD test volume growth is reasonable to assume now and looking forward?
  • Where MRD usage or impact is most pronounced? Is it neo-adjuvant, adjuvant, or surveillance settings? What stage of cancer?
  • What are the key factors that influence MRD usage (volumes) and the choice of test or vendor? What is the market share?
  • Is NTRA’s dominant position confirmed from our survey and if so, is it durable?
  • What is the opportunity for other MRD vendors (public & private)?
  • Is MRD viewed as having prognostic or predictive value?
  • Does MRD require a confirmatory or scan or can MRD be used alone to influence treatment decisions?
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