OnCo
ideasIdea

Intercepting late recurrence with ctDNA surveillance and oral SERDs

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.

Combine tumour-informed ctDNA surveillance in years 3-10 of adjuvant therapy with randomised intervention (add or switch to an oral SERD, or add a CDK4/6 inhibitor) at molecular relapse.

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.
What would test it
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

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