# A national platform trial that every ctDNA-positive patient can join

Source: https://onco.cc/ideas/idea-bio2-national-mrd-platform/  
OnCo record `idea-bio2-national-mrd-platform` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Blood tests can now find leftover cancer months before scans, but most patients who test positive have nothing to enrol in. One standing trial per country would fix that.

## Summary

MRD-guided intervention has proved feasible in bladder cancer and colorectal cancer, but each trial rebuilds the same infrastructure: assay contracts, testing schedules, referral pathways and consent. A standing national platform (one master protocol, shared control arm, rolling arms contributed by any sponsor, registry-based follow-up) converts a scattered set of underpowered studies into a permanent engine for the MRD setting.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A national MRD platform doubles the proportion of ctDNA-positive patients enrolled in an interventional trial within three years and reduces the cost per randomised patient by half compared with standalone MRD trials.
- Rationale: Platform infrastructure has repeatedly outperformed serial standalone trials in speed and cost, as seen in adaptive platforms in breast cancer and in pandemic therapeutics. The MRD setting is unusually well suited because the eligibility test is a single blood assay.
- Proposed test: Stand up the platform in one tumour type with two arms and a shared control, and measure enrolment rate, time from positive test to randomisation, and cost per randomised patient against historical standalone MRD trials.
- Maturity: being-tested-at-scale
- Actor: policy

## Sources

- Bottleneck evidence (Dormant cells and minimal residual disease): Tie et al., ctDNA analysis guiding adjuvant therapy in stage II colon cancer (NEJM 2022): https://doi.org/10.1056/NEJMoa2200075

## Connected records

- technologies: [AI trial matching & clinical decision support](https://onco.cc/technologies/ai-trial-matching/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- companies: [ECOG-ACRIN Cancer Research Group](https://onco.cc/companies/ecog-acrin/)
- institutions: [Cancer Research UK](https://onco.cc/institutions/cruk/), [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- terms: [Basket, umbrella, and platform trials](https://onco.cc/terms/basket-umbrella-platform/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/)
- trials: [CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)](https://onco.cc/trials/circulate-japan/), [DYNAMIC](https://onco.cc/trials/dynamic/), [IMvigor011](https://onco.cc/trials/imvigor011/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/), [Trials enrol too few, too slowly](https://onco.cc/bottlenecks/b-trial-enrolment/)
- roadmaps: [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/)

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