# Intercepting late recurrence with ctDNA surveillance and oral SERDs

Source: https://onco.cc/ideas/idea-late-recurrence-interception/  
OnCo record `idea-late-recurrence-interception` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Half of hormone-positive recurrences happen after year five. Blood tests during long-term follow-up could find them early and an oral SERD might stop them.

## Summary

This speculative idea would run tumour-informed ctDNA surveillance, such as Signatera, in years 3 to 10 of adjuvant endocrine therapy for HR-positive breast cancer and randomise women with molecular relapse to an oral SERD such as camizestrant or giredestrant, with or without a CDK4/6 inhibitor. Many recurrences occur after year five, ctDNA anticipates clinical relapse by around a year in the c-TRAK TN and ZEST experience, and dormant micrometastases may still be endocrine-sensitive. The hypothesis is that treating molecular relapse this way delays or prevents clinical distant recurrence. The test would be a TREAT-ctDNA or ZEST-style trial, where feasibility of detection is the first hurdle; the idea addresses the dormancy and minimal residual disease bottleneck.

## Fields

- Kind: Idea
- Last checked: 2026-09-07
- Hypothesis: ctDNA-detected molecular relapse treated with an oral SERD ± CDK4/6 inhibitor delays or prevents clinical distant recurrence versus standard care.
- Rationale: ctDNA anticipates clinical relapse by a median of about a year in HR+ disease (c-TRAK TN, ZEST experience); dormant micrometastases may remain endocrine-sensitive.
- Proposed test: A TREAT-ctDNA / ZEST-style trial in HR+ disease with an oral SERD intervention; feasibility of detection rates during adjuvant ET is the first hurdle.
- Maturity: speculative

## Sources

- GALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfold (Nature Medicine 2023): https://doi.org/10.1038/s41591-022-02115-4

## Connected records

- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- technologies: [Anxiety around scans, and what the evidence says about how often to scan](https://onco.cc/technologies/rejuv-mind-scan-anxiety/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- drugs: [Camizestrant](https://onco.cc/drugs/camizestrant/), [Giredestrant](https://onco.cc/drugs/giredestrant/), [Signatera](https://onco.cc/drugs/signatera/)
- terms: [Late recurrence](https://onco.cc/terms/late-recurrence/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/)
- key papers: [Camizestrant, a next-generation oral SERD, versus fulvestrant in post-menopausal women with oestrogen receptor-positive, HER2-negative advanced breast cancer (SERENA-2): a multi-dose, open-label, randomised, phase 2 trial](https://onco.cc/key-papers/paper-nct04214288-lancet-oncol-2024/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/)

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