{"entity":{"id":"idea-late-recurrence-interception","kind":"idea","name":"Intercepting late recurrence with ctDNA surveillance and oral SERDs","aka":[],"tldr":"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.","asOf":"2026-09-07","links":[{"label":"GALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfold (Nature Medicine 2023)","url":"https://doi.org/10.1038/s41591-022-02115-4"}],"tags":[],"related":[],"cancers":["breast-hr-positive"],"sections":[],"technologies":["mrd-testing"],"targets":[],"drugs":["camizestrant","giredestrant","signatera"],"companies":[],"institutions":[],"pathways":[],"terms":["late-recurrence","mrd"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-nct04214288-lancet-oncol-2024"],"journals":[],"dependsOn":[],"notes":[],"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.","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"},"route":"/ideas/idea-late-recurrence-interception/","neighbours":{"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"technology":[{"id":"rejuv-mind-scan-anxiety","kind":"technology","name":"Anxiety around scans, and what the evidence says about how often to scan","route":"/technologies/rejuv-mind-scan-anxiety/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"drug":[{"id":"camizestrant","kind":"drug","name":"Camizestrant","route":"/drugs/camizestrant/"},{"id":"giredestrant","kind":"drug","name":"Giredestrant","route":"/drugs/giredestrant/"},{"id":"signatera","kind":"drug","name":"Signatera","route":"/drugs/signatera/"}],"term":[{"id":"late-recurrence","kind":"term","name":"Late recurrence","route":"/terms/late-recurrence/"},{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"}],"paper":[{"id":"paper-nct04214288-lancet-oncol-2024","kind":"paper","name":"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","route":"/key-papers/paper-nct04214288-lancet-oncol-2024/"}],"bottleneck":[{"id":"b-dormancy-mrd","kind":"bottleneck","name":"Dormant cells and minimal residual disease","route":"/bottlenecks/b-dormancy-mrd/"}]}}