Elacestrant for Treating ER+/HER2- Breast Cancer Patients With ctDNA Relapse (TREAT ctDNA)
NCT ID: NCT05512364
Last Updated: 2025-08-19
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
PHASE3
220 participants
INTERVENTIONAL
2023-12-15
2035-11-01
Brief Summary
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During the ctDNA screening phase, patients will be tested at different timepoints to detect the presence of ctDNA in their blood.
Patients who are found to be ctDNA-positive and have no evidence of distant metastasis, will be randomised 1:1 between standard endocrine treatment (the same they were receiving when tested ctDNA positive) versus elacestrant, provided they meet all eligibility criteria. After completion of the protocol treatment period, treatment will be left at the discretion of the treating physician.
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Detailed Description
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1. ctDNA screening phase: After verification of the eligibility criteria for screening, patients will enter the ctDNA screening phase of the study in which plasma samples will be collected and tested with ctDNA assay to detect the presence of ctDNA. The test will be performed every 6 months from study entry until the end of accrual (approximately 5.7 years). During the screening phase, patients will be treated with standard adjuvant endocrine therapy \[either tamoxifen or an aromatase inhibitor (exemestane, anastrozole or letrozole)\] and followed-up as per standard of care. The outcome of the serial ctDNA assessments performed during the screening phase will be disclosed to investigators.
Patients who are found to be ctDNA-negative at the end of the screening period will not be followed further in this study.
Patients who are found to be ctDNA-positive at one of the screening time points will undergo an imaging work-up to assess the presence of distant metastases.
Patients for whom the imaging work-up confirms no evidence of distant metastases or locoregional recurrence will be eligible for the randomised phase of the study provided they meet all other eligibility criteria. Patients for whom the imaging work-up shows evidence of distant metastases or locoregional recurrence will be excluded.
2. Randomised trial:
Patients will be randomised 1:1 within 4 weeks from the date of ctDNA detection (i.e., the date on which the results of the test are received) between standard endocrine treatment (the same they were receiving when tested ctDNA positive) versus elacestrant.
In the absence of a withdrawal criteria, treatment in both arms will be administered for:
* For patients on ET between 1 to 5 years (12 to 60 months) at the time of randomisation: 2 to 6 years (allowing for 7 years of ET at the end of the study treatment).
* For patients on ET between 5 to 7.5 years (60 to 90 months) at the time of randomisation: 2 years.
After completion of the protocol treatment period, treatment will be left at the discretion of the treating physician.
Patients in both arms will undergo intensive follow-up with ctDNA tests at week 4 and week 16 after randomisation and every 16 weeks thereafter for a maximum of 3 years (36 months or 156 weeks) to assess ctDNA kinetics. In addition, the occurrence of distant metastases, locoregional recurrences and second cancers will be assessed via yearly mammograms and bone scans and 16-weekly CT scans thorax/abdomen for a maximum of 3 years after randomisation. Afterwards, follow-up will continue as per standard of care. All randomised patients will be followed-up until 3 years after the enrolment of the last patient.
End of study:
End of study occurs when all the following criteria have been satisfied:
All patients have completed their end of study visit. If a patient discontinues the follow-up due to withdrawal of consent, loss to follow-up, or death, the end of study participation is defined as the time point when one of these events occurred The trial is mature for all analyses defined in the protocol and the database has been cleaned and frozen for these analyses.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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Experimental arm
elacestrant 400 mg/day orally once daily on a continuous dosing schedule
Elacestrant
400mg QD orally on a continuous dosing schedule
Control arm
standard endocrine treatment - the same they were receiving at the time of ctDNA detection
Tamoxifen
20 mg QD orally on a continuous dosing schedule
Letrozole 2.5mg
2.5 mg QD orally on a continuous dosing schedule
Anastrozole 1mg
1 mg QD orally on a continuous dosing schedule
Exemestane 25 MG
25 mg QD orally on a continuous dosing schedule
Interventions
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Elacestrant
400mg QD orally on a continuous dosing schedule
Tamoxifen
20 mg QD orally on a continuous dosing schedule
Letrozole 2.5mg
2.5 mg QD orally on a continuous dosing schedule
Anastrozole 1mg
1 mg QD orally on a continuous dosing schedule
Exemestane 25 MG
25 mg QD orally on a continuous dosing schedule
Eligibility Criteria
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Inclusion Criteria
• Female (both pre- and postmenopausal) or male patients with histologically confirmed ER positive (regardless of PR),
HER2 negative breast cancer, according to local pathologist:
* ER-positive defined as ≥ 10% of cells staining positive for ER or Allred proportion score ≥3
* HER2-negative defined as a score of 0, 1+ by immunohistochemistry (IHC) or a negative in situ hybridization (ISH) based on single-probe average HER2 copy number, as per American Society of Clinical Oncology guidelines
* Intermediate to high risk of recurrence after definitive treatment for early breast cancer, defined as:
FOR PATIENTS TREATED WITH PRIMARY SURGERY:
* Any patient with ≥ 4 positive axillary lymph nodes (stage pN2-3).
* 1-3 positive axillary lymph nodes (stage pN1) and either:
* Tumour size ≥ 5 cm or/and
* Histologic grade 3 or/and
* Ki67≥20% or/and
* High genomic risk defined as Oncotype Dx Recurrence Score \>=26, Mammaprint high risk, Prosigna score \>40 or EPclin risk score \>=4.0.
* Negative axillary lymph nodes (stage pN0) and tumour size ≥ 5 cm and either
* Histologic grade 3 a or/and
* Ki67≥20% and/or
* High genomic risk defined as Oncotype Dx Recurrence Score \>=26, Mammaprint high risk, Prosigna score \>60 or EPclin risk score \>=4.0. FOR PATIENTS TREATED WITH NEOADJUVANT
SYSTEMIC TREATMENT FOLLOWED BY SURGERY:
* Patient may have received neoadjuvant endocrine therapy or neoadjuvant chemotherapy provided that:
* The initial tumour and/or the tumour after surgery meet the criteria above defined for patients treated with primary surgery or the initial tumour was staged as cT4anyN and
* There is no pathological complete response, defined as no invasive disease in the breast and axilla (ypT0/is ypN0).
* Age ≥18 years
* Patients must have received at least 1 year and up to 7.5 years of ET and planned to continue adjuvant ET during ctDNA screening phase
* Previous adjuvant CDK4/6 inhibitor or PARP-inhibitor treatment is allowed provided it is completed
* Invasive multicentric / multifocal disease is allowed provided that all the tested foci are ER+ HER2-. A sample from the highest-risk one, according to the investigator decision based on the size and grade, should be sent to Natera to build the patient ctDNA assay.
* Available tumour sample from resected or biopsied tissue, with a tumour content of ≥20% (30% preferred) either before or after macro dissection (if performed) and a cell viability of a minimum 100 cells.
* Core Needle Biopsies (CNB): recommended minimum of four (4) cores per block
* Fine Needle Aspirates (FNA) are not accepted
* The following sample types are acceptable:
* 6-10 unstained slides (charged and unbaked) of 10μm each (or 12-19 unstained slides at 5 μm each), PLUS one contiguous H\&E slide. Minimum total tissue thickness must be 60μm OR
* FFPE tissue block with 25mm2 minimum surface area
* Written informed consent must be given according to ICH/GCP, and national/local regulations.
* ctDNA positive according to the Signatera ctDNA assay (main study ctDNA test) or other ctDNA assay approved for diagnostic purposes.
* Patients must meet the eligibility criteria for the screening phase, with the exception of the tissue sample requirements.
* Patients must receive adjuvant ET at the time of the ctDNA positive test
* Absence of locoregional and/or metastatic disease and/or new malignancy, as investigated by:
* Mammogram (unilateral in case of mastectomy; not required in patients having undergone bilateral mastectomy) NOTE: if local investigator plans to use MRIs instead of mammograms during the study, MRI will have to be performed at baseline.
* CT thorax and abdomen/pelvis with IV contrast. In case of any contra-indications (medical or regulatory): CT thorax without contrast + MRI abdomen/pelvis.
* Technetium-99m bone scintigraphy
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1
* Adequate organ function
* Women of childbearing potential (WOCBP) must have a negative highly sensitive serum or urine pregnancy test within 7 days prior to randomisation.
Exclusion Criteria
* Previous history of invasive breast cancer
* Previous history of any other malignancy within the last 5 years, except for adequately treated basal cell or squamous cell skin cancer, or carcinoma in situ.
* Previous history of bone marrow and/or organ transplant
* Bilateral breast cancer
* Participation in another clinical study, with the exception of the SURVIVE study and observational (non-interventional) and non-drug intervention clinical studies. Note: patients participating in interventional studies may participate once they enter the follow-up period of the study
* Blood transfusion within 3 months prior to registration or during the screening.
2. Randomised trial:
* Any unresolved toxic effect of prior therapies or surgical procedures of Grade ≥ 2 according to Common Terminology Criteria of Adverse Events (CTCAE) v5.0, with the exception of alopecia, peripheral neuropathy and other toxicities not considered a safety risk for the participant at investigator's discretion
* Unable or unwilling to avoid over-the-counter medications, dietary/herbal supplements, and/or foods that are moderate/strong inhibitors or inducers of CYP3A4 activity
* Known difficulty in tolerating oral medications or conditions which would impair absorption of oral medications
* Any of the following cardiovascular disorders within 3 months before enrolment:
* myocardial infarction
* stroke
* severe/unstable angina
* symptomatic cardiac arrhythmia
* prolonged QTcF ≥ Grade 3 (i.e., \> 500 msec)
* heart failure ≥ Class III as defined by the New York Heart Association (NYHA) guidelines
* Child-Pugh Score greater than Class A
* Uncontrolled significant active infections (≥ grade 3 according to CTCAE version 5), including active hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency Virus (HIV)
* Coagulopathy or any history of coagulopathy within the past 6 months, including history of deep vein thrombosis or pulmonary embolism
18 Years
ALL
No
Sponsors
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European Organisation for Research and Treatment of Cancer - EORTC
NETWORK
Breast International Group
OTHER
Menarini Group
INDUSTRY
Responsible Party
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Principal Investigators
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Michail Ignatiadis
Role: STUDY_CHAIR
Institut Jules Bordet, Belgium
Emmanouil Saloustros
Role: STUDY_CHAIR
General University Hospital of Larissa, Greece
Locations
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Institut Jules Bordet
Anderlecht, , Belgium
AZ KLINA
Brasschaat, , Belgium
Cliniques Universitaires Saint-Luc
Brussels, , Belgium
Grand Hopital de Charleroi - Site Notre Dame
Charleroi, , Belgium
CHU Helora Pole Hospitalier Jolimont - Hopital Jolimont
Haine-Saint-Paul, , Belgium
AZ Groeninge Kortrijk - Campus Kennedylaan
Kortrijk, , Belgium
U.Z. Leuven - Campus Gasthuisberg
Leuven, , Belgium
CHU Site Sainte-Elisabeth-UCL Namur
Namur, , Belgium
AZ Delta - Campus Rumbeke
Roeselare, , Belgium
AZ Turnhout - Campus Sint Elisabeth
Turnhout, , Belgium
Centre Hospitalier Regional Verviers
Verviers, , Belgium
German Oncology Center
Limassol, , Cyprus
Bank Of Cyprus Oncology Centre
Stróvolos, , Cyprus
CH de La Cote Basque - Saint Leon
Bayonne, , France
Clinique Belharra-Ramsay Sante
Bayonne, , France
Centre de Radiotherapie Pierre Curie
Beuvry, , France
Centre Hospitalier - Boulogne Sur Mer
Boulogne-sur-Mer, , France
CHU de Lyon - Hopital Femme Mere Enfant
Bron, , France
Societe de Recherche Oncologique Clinique 37
Chambray-lès-Tours, , France
Hopital de Douai- Centre Leonard de Vinci
Dechy, , France
CHU de Limoges - Hopital Dupuytren
Limoges, , France
CHU de Lyon - Hopital De La Croix Rousse
Lyon, , France
Polyclinique De Gentilly - Centre d'Oncologie
Nancy, , France
CHU de Lyon - Hopital Lyon Sud
Pierre-Bénite, , France
Institut Curie - l'Hopital de St Cloud
Saint-Cloud, , France
CHU de Toulouse - Institut Claudius Regaud - IUCT oncopole
Toulouse, , France
Universitaetsklinikum Aachen AOR - Medizinische Fakultaet der RWTH
Aachen, , Germany
Gemeinschaftspraxis Augsburg
Augsburg, , Germany
Evangelisches Krankenhaus -Bergisch Gladbach
Bergisch Gladbach, , Germany
Marienhospital Bottrop gGmbH
Bottrop, , Germany
Hamatologische Onkologische Praxis Im Medicum
Bremen, , Germany
St Elisabeth-Krankenhaus
Cologne, , Germany
Universitaetsklinikum Carl Gustav Carus (TUD)
Dresden, , Germany
Medizinische Hochschule Hannover
Hanover, , Germany
Gemeinschaftspraxis Dr. Pourfard / Dr. Uleer
Hildesheim, , Germany
Klinikum Kassel Gmbh
Kassel, , Germany
MVM MbH -Onkologie UnterEms, Leer-Papenburg-Emden
Leer, , Germany
Busch MCZ GmbH
Mühlhausen, , Germany
Klinikum Nuernberg- Standort Nord
Nuremberg, , Germany
Klinikum Ernst von Bergmann gemeinnützige GmbH
Potsdam, , Germany
Universitaetsklinikum Tuebingen-calwerstrasse
Tübingen, , Germany
Universitaetsklinikum Ulm-Michelsberg
Ulm, , Germany
HELIOS Kliniken - Helios Klinikum Wuppertal - Klin. Univ. Witten / Herdecke
Wuppertal, , Germany
Diagnostic & Therapeutic Center of Athens Hygeia Hospital S.A.
Athens, , Greece
General University Hospital of Larissa
Larissa, , Greece
Mater Private Hospital
Dublin, , Ireland
St. James'S Hospital
Dublin, , Ireland
Beacon Hospital
Dublin, , Ireland
Centro Di Riferimento Oncologico
Aviano, , Italy
Azienda Ospedaliera Papa Giovanni XXIII
Bergamo, , Italy
Univ. of Florence -Azienda Ospedaliero-Universitaria Careggi
Florence, , Italy
IRCCS Azienda Policlinico San Martino
Genova, , Italy
Azienda USL IRCCS Di Reggio Emilia Guastalla
Guastalla, , Italy
Ospedale Alessandro Manzoni
Lecco, , Italy
Azienda Unita Locale Socio-Sanitaria N. 9-Mater Salutis Hospital
Legnano, , Italy
IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"
Meldola, , Italy
University Hospital of Cagliari Duilio Casula Hospital Unit (Policlinico)
Monserrato, , Italy
Azienda Ospedaliera Universitaria "Federico II"
Napoli, , Italy
Azienda Ospedaliero-Universitaria di Parma
Parma, , Italy
Istituti Clinici Scientifici Maugeri
Pavia, , Italy
San Maria della Misericordia Hospital
Perugia, , Italy
Azienda Ospedaliera Universitaria Pisana
Pisa, , Italy
Azienda USL IRCCS Di Reggio Emilia - Maria Nuova
Reggio Emilia, , Italy
AUSL Romagna - AUSL Della Romagna - Infermi Hospital -Rimini
Rimini, , Italy
Flevoziekenhuis Stichting
Almere Stad, , Netherlands
Amsterdam UMC - locatie VUMC
Amsterdam, , Netherlands
Rijnstate Hospital
Arnhem, , Netherlands
Haaglanden Medisch Centrum
Leidschendam, , Netherlands
Ikazia Ziekenhuis
Rotterdam, , Netherlands
Sint Antonius - St Antonius Ziekenhuis Utrecht
Utrecht, , Netherlands
VieCuri - Medisch Centrum voor Noord-Limburg - Locatie Venlo
Venlo, , Netherlands
Hospital General Universitario Doctor Balmis
Alicante, , Spain
Hospital Universitario De Cruces
Barakaldo, , Spain
Hospital Clinico Universitario - Virgen De La Arrixaca
El Palmar, , Spain
ICO Girona - Hospital Doctor Josep Trueta
Girona, , Spain
Hospital Universitario Virgen De Las Nieves
Granada, , Spain
Hospital Universitario Clinico San Cecilio
Granada, , Spain
ICO L'Hospitalet - Hospital Duran i Reynals
L'Hospitalet de Llobregat, , Spain
Hospital Universitari Arnau De Vilanova
Lleida, , Spain
Hospital Universitario 12 De Octubre
Madrid, , Spain
Hospitales HM Sanchinarro-CIOCC
Madrid, , Spain
Althaia Xarxa Assistencial Universitaria De Manresa Fundacio Privada
Manresa, , Spain
Hospital Universitari Son Espases
Palma de Mallorca, , Spain
Hospital Universitario de Navarra
Pamplona, , Spain
Hospital Sant Joan de Reus
Reus, , Spain
Hospital Quironsalud Sagrado Corazon
Seville, , Spain
University Hospital Virgen del Rocio
Seville, , Spain
Hospital Universitario Virgen De La Macarena
Seville, , Spain
Hospital Clinico Universitario De Valencia
Valencia, , Spain
Hospital Universitario Y Politecnico La Fe
Valencia, , Spain
Sodra Alvsborgs Sjukhus - Vastra Gotalandsregionen
Borås, , Sweden
Karolinska University Hospital, location Solna
Stockholm, , Sweden
Kantonsspital Frauenfeld- Breast Unit Thurgau
Frauenfeld, , Switzerland
Buergerspital Solothurn -Brustzentrum
Solothurn, , Switzerland
Countries
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Central Contacts
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Other Identifiers
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EORTC-2129-BCG
Identifier Type: -
Identifier Source: org_study_id
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