{"entity":{"id":"altair","kind":"trial","name":"ALTAIR","aka":[],"tldr":"Treating the blood test result before the cancer shows up on a scan did not work. It delayed relapse by about four months and caused severe blood toxicity in three-quarters of patients.","summary":"ALTAIR was the double-blind randomised phase 3 trial embedded in the CIRCULATE-Japan platform. Patients with resected colorectal cancer who became ctDNA-positive after completing standard-of-care therapy, with no radiological evidence of disease, were randomised 1:1 to trifluridine/tipiracil or placebo for six months. Between July 2020 and June 2023, 243 patients were randomised (122 to the drug, 121 to placebo). Median disease-free survival was 9.30 against 5.55 months (hazard ratio 0.79, 95% CI 0.60 to 1.05, p=0.107) and the primary endpoint was not met. Grade 3 or higher haematological adverse events occurred in 73.0 against 3.3 percent. The conclusion is that late-line chemotherapy started at molecular recurrence does not clear minimal residual disease, and that a better drug, not earlier timing, is what ctDNA-positive patients need.","status":"negative","asOf":"2026-09-24","links":[{"label":"ClinicalTrials.gov NCT04457297","url":"https://clinicaltrials.gov/study/NCT04457297"},{"label":"ALTAIR: post-adjuvant chemotherapy in ctDNA-positive patients with resected colorectal cancer (Nature Medicine 2026)","url":"https://doi.org/10.1038/s41591-026-04428-0"},{"label":"CIRCULATE-Japan: ctDNA-guided adaptive platform trials (Cancer Science 2021)","url":"https://doi.org/10.1111/cas.14926"}],"tags":[],"related":[],"cancers":["colorectal"],"sections":[],"technologies":["mrd-testing","liquid-biopsy"],"targets":[],"drugs":["trifluridine-tipiracil","signatera"],"companies":[],"institutions":["ncc-japan"],"pathways":[],"terms":["mrd","ctdna"],"trials":["circulate-japan","dynamic-iii"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT04457297","phase":"3","setting":"Resected stage 0 to IV colorectal cancer that became ctDNA-positive after standard treatment, with no disease visible on scans: six months of trifluridine/tipiracil against placebo","sponsor":"National Cancer Center Hospital East","result":"Median disease-free survival 9.30 against 5.55 months (hazard ratio 0.79, p=0.107): primary endpoint not met.","yearReported":2026,"enrolled":243,"enrolledBasis":"registry","outcomes":[{"endpoint":"Disease-free survival","primary":true,"unit":"months","arms":[{"name":"Trifluridine/tipiracil","n":122,"value":9.3},{"name":"Placebo","n":121,"value":5.55}],"hr":0.79,"ci":[0.6,1.05],"p":"0.107","source":"https://doi.org/10.1038/s41591-026-04428-0"}],"replication":"DYNAMIC-III reached the same conclusion for escalation in ctDNA-positive stage III disease."},"route":"/trials/altair/","neighbours":{"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"technology":[{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"drug":[{"id":"signatera","kind":"drug","name":"Signatera","route":"/drugs/signatera/"},{"id":"trifluridine-tipiracil","kind":"drug","name":"Trifluridine/tipiracil","route":"/drugs/trifluridine-tipiracil/"}],"institution":[{"id":"ncc-japan","kind":"institution","name":"National Cancer Center Hospital","route":"/institutions/ncc-japan/"}],"term":[{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"colorectal-failed-programmes","kind":"term","name":"Colorectal cancer: the failed and stopped programmes, and why","route":"/terms/colorectal-failed-programmes/"},{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"}],"trial":[{"id":"bespoke-crc","kind":"trial","name":"BESPOKE CRC","route":"/trials/bespoke-crc/"},{"id":"circulate-japan","kind":"trial","name":"CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)","route":"/trials/circulate-japan/"},{"id":"circulate-us","kind":"trial","name":"CIRCULATE-US","route":"/trials/circulate-us/"},{"id":"dynamic","kind":"trial","name":"DYNAMIC","route":"/trials/dynamic/"},{"id":"dynamic-iii","kind":"trial","name":"DYNAMIC-III","route":"/trials/dynamic-iii/"},{"id":"tracc","kind":"trial","name":"TRACC","route":"/trials/tracc/"}]}}