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Recent advancements in molecular residual disease (MRD) testing based on circulating tumor DNA (ctDNA) analysis have shown considerable promise in the context of predicting recurrence; however, significant barriers to widespread clinical implementation remain\u2014mainly, low awareness among healthcare professionals, high costs, and lack of standardized assays and comprehensive evidence. This position paper, led by the Japan Society of Clinical Oncology, aims to establish a common framework for the appropriate clinical use of MRD testing in a tumor type-agnostic manner. It synthesizes currently available evidence, reviews region-specific clinical trends, addresses critical clinical questions related to MRD testing, and offers recommendations to guide healthcare professionals, biotechnology and pharmaceutical companies, and regulatory authorities. These recommendations were developed based on a voting process involving 15 expert members, ensuring a consensus-driven approach. 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Hideaki Bando reports honoraria from Taiho Pharmaceutical, Ono Pharmaceutical, and Eli Lilly Japan and research funding from Ono Pharmaceutical. Eiji Oki reports honoraria from Bristol-Myers Squibb, Taiho Pharmaceutical, Chugai Pharmaceutical, Eli Lilly Japan, Takeda Pharmaceutical, Ono Pharmaceutical, Daiichi Sankyo, and Bayer Yakuhin and research funding from Guardant Health Japan. Hidehito Horinouchi reports honoraria from AstraZeneca, Chugai Pharmaceutical, and AbbVie and research funding from AbbVie, AstraZeneca, Chugai Pharmaceutical, and Bristol Myers Squibb. Yukinori Ozaki reports honoraria from Pfizer, Kyowa Kirin, Daiichi Sankyo, Eli Lilly Japan, and Chugai Pharmaceutical. Hiroji Iwata reports honoraria from AstraZeneca and Daiichi Sankyo and research funding from AstraZeneca, Daiichi Sankyo, Pfizer, and Chugai Pharmaceutical. Akihiro Ohba reports honoraria from Ono Pharmaceutical and research funding from Ono Pharmaceutical, Novartis Pharma, and Chugai Pharmaceutical. Taigo Kato reports honoraria from MSD. Hideaki Miyake reports honoraria from Janssen Pharmaceutical, Takeda Pharmaceutical, MSD, Eisai, Astellas, Sanofi, Pfizer, Sysmex, Ono Pharmaceutical, Astellas, and AstraZeneca; research funding from Ono Pharmaceutical, MSD, and Pfizer; and scholarship donations from PDRadiopharma, Takeda Pharmaceutical, and FUJIFILM. Masafumi Ikeda reports honoraria from Taiho Pharmaceutical, Novartis Pharma, Chugai Pharmaceutical, Nihon Servier, MSD, AstraZeneca, Teijin Pharma, Incyte Biosciences Japan, Eisai, and Takeda Pharmaceutical and research funding from MSD, Eisai, Chiome Bioscience, Syneos Health Clinical, Novartis Pharma, Eli Lilly Japan, Chugai Pharmaceutical, Bristol-Myers Squibb, Nihon Servier, Merus N.V., INVITAE, Delta-Fly Pharma, AstraZeneca, J-Pharma, Merck Biopharma, and Chiome Bioscience. Tatsuyuki Chiyoda reports research funding from Takeda Pharmaceutical and JSR. Kosei Hasegawa reports honoraria from Sanofi, MSD, Takeda Pharmaceutical, Chugai Pharmaceutical, and AstraZeneca and research funding from MSD and Takeda Pharmaceutical. Kenjiro Namikawa reports honoraria from Novartis Pharma. Takayuki Yoshino reports honoraria from Chugai Pharmaceutical, Takeda Pharmaceutical, Merck Biopharma, Bayer Yakuhin, Ono Pharmaceutical, MSD K.K, and Sumitomo Corp.; research funding from Amgen, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, FALCO biosystems, Genomedia, Medical & Biological Laboratories, Merus N.V., Molecular Health GmbH, MSD, Nippon Boehringer Ingelheim, Ono Pharmaceutical, Pfizer Japan, Roche Diagnostics, Sanofi, Sysmex, Taiho Pharmaceutical, and Takeda Pharmaceutical. Kiyoshi Hasegawa reports honoraria from Eisai and Chugai Pharmaceutical, research funding from Mochida Pharmaceutical and FUJIFILM Healthcare Laboratory, and scholarship donations from Taiho Pharmaceutical. The other authors declare no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}