ctDNA has emerged as a noninvasive diagnostic and prognostic tool for colorectal cancer. The role of ctDNA in total neoadjuvant therapy and nonoperative management of locally advanced rectal cancer is uncertain. In this study, we discuss a ctDNA biomarker analysis of rectal cancer patients undergoing neoadjuvant therapy from the NOMINATE trial. See related article by Akiyoshi et al., p. 5188.