# CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)

Source: https://onco.cc/trials/circulate-japan/  
OnCo record `circulate-japan` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Japan's national programme tests whether a blood test after surgery should decide who gets chemotherapy, and whether treating a positive test early helps.

## Summary

GALAXY (observational, >2,000 patients) showed ctDNA positivity 4 weeks post-surgery is the strongest predictor of recurrence (Nature Medicine 2023). ALTAIR (ctDNA-positive, randomised to trifluridine/tipiracil vs placebo) missed its DFS endpoint (2024), suggesting late-line chemotherapy does not clear MRD. VEGA (ctDNA-negative, omit vs give CAPOX) is ongoing. Together with DYNAMIC these define the state of ctDNA-guided adjuvant therapy in CRC.

## Fields

- Kind: Trial
- Status: active
- Last checked: 2026-09-07
- Also known as: GALAXY; VEGA; ALTAIR
- Phase: 3
- Setting: Resected stage II-IV colorectal cancer: ctDNA (Signatera) to guide adjuvant chemotherapy de-escalation (VEGA) or escalation with trifluridine/tipiracil (ALTAIR)
- Sponsor: National Cancer Center Japan
- Result: GALAXY: ctDNA+ post-op HR for recurrence ~10; ALTAIR: DFS endpoint not met.
- Outcomes: GALAXY (observational): recurrence risk by post-operative ctDNA status (4 weeks after surgery): ctDNA-positive vs ctDNA-negative, HR 10; ALTAIR (randomised phase 3): disease-free survival in post-adjuvant ctDNA-positive patients: Trifluridine/tipiracil 9.3 months vs Placebo 5.55 months, HR 0.79
- Replication: GALAXY's prognostic ctDNA signal matches DYNAMIC, CIRCULATE-PRODIGE and BESPOKE cohorts; the interventional ALTAIR arm shows that detecting molecular recurrence does not yet translate into a DFS gain with trifluridine/tipiracil. VEGA (de-escalation) still pending.

## Sources

- GALAXY, Nature Medicine 2023: https://www.nature.com/articles/s41591-022-02115-4
- ALTAIR: post-adjuvant chemotherapy in ctDNA-positive patients with resected colorectal cancer (Nature Medicine 2026): https://doi.org/10.1038/s41591-026-04428-0

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- technologies: [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- drugs: [CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [Signatera](https://onco.cc/drugs/signatera/), [Trifluridine/tipiracil](https://onco.cc/drugs/trifluridine-tipiracil/)
- institutions: [National Cancer Center Hospital](https://onco.cc/institutions/ncc-japan/)
- terms: [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Colectomy](https://onco.cc/terms/colectomy/), [De-escalation, escalation and response-adapted therapy](https://onco.cc/terms/de-escalation/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Real-world evidence](https://onco.cc/terms/real-world-evidence/), [Registry-based randomised trial](https://onco.cc/terms/registry-based-trial/), [Trial registration and results reporting (ClinicalTrials.gov, EU CTR)](https://onco.cc/terms/trial-registration/)
- trials: [ALTAIR](https://onco.cc/trials/altair/), [CIRCULATE-US](https://onco.cc/trials/circulate-us/), [DYNAMIC](https://onco.cc/trials/dynamic/), [DYNAMIC-III](https://onco.cc/trials/dynamic-iii/), [TRACC](https://onco.cc/trials/tracc/)
- people: [Jeanne Tie](https://onco.cc/people/jeanne-tie/), [Takayuki Yoshino](https://onco.cc/people/yoshino-takayuki/)
- key papers: [Circulating tumor DNA in stage III colorectal cancer, beyond minimal residual disease detection, toward assessment of adjuvant therapy efficacy and clinical behavior of recurrences](https://onco.cc/key-papers/paper-henriksen-ctdna-stage-iii-colorectal-improve-it-ccr-2022/), [Circulating tumor DNA-guided treatment with pertuzumab plus trastuzumab for HER2-amplified metastatic colorectal cancer: a phase 2 trial (TRIUMPH)](https://onco.cc/key-papers/paper-nakamura-triumph-ctdna-pertuzumab-trastuzumab-her2-colorectal-nat-med-2021/), [GALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfold](https://onco.cc/key-papers/paper-galaxy-signatera-nat-med-2023/)
- ideas: [A national platform trial that every ctDNA-positive patient can join](https://onco.cc/ideas/idea-bio2-national-mrd-platform/), [ctDNA-guided adjuvant therapy as the default in stage II-III colon cancer](https://onco.cc/ideas/idea-ctdna-guided-adjuvant-crc/), [Formally qualify tumour-DNA blood tests as a surrogate endpoint for adjuvant trials](https://onco.cc/ideas/idea-tr2-ctdna-mrd-qualification/), [Strip the platelet coat off travelling tumour cells in ctDNA-positive patients](https://onco.cc/ideas/idea-bio2-platelet-cloak-aspirin-mrd/), [Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps](https://onco.cc/ideas/idea-crc-ctdna-de-escalation-beyond-stage-ii/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/), [ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment](https://onco.cc/roadmaps/ctdna-tests/), [Diagnostics roadmap: stains → gene panels → blood tests that decide treatment](https://onco.cc/roadmaps/diagnostics-roadmap/), [Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on](https://onco.cc/roadmaps/trial-modernisation-roadmap/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [Metastasis is understood least and studied last](https://onco.cc/bottlenecks/b-metastasis-biology/), [Tumour heterogeneity and clonal evolution](https://onco.cc/bottlenecks/b-tumor-heterogeneity/)

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