Elacestrant for Treating ER+/HER2- Breast Cancer Patients With ctDNA Relapse (TREAT ctDNA)

NCT ID: NCT05512364

Last Updated: 2025-08-19

Study Results

Results pending

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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Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

220 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-15

Study Completion Date

2035-11-01

Brief Summary

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This is an international, multi-center, randomised, open label, superiority phase III trial of elacestrant vs standard endocrine therapy in patients with ER+/HER2- breast cancer and ctDNA relapse.

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.

Detailed Description

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International, multi-center, randomised, open label, superiority phase III trial of elacestrant vs standard endocrine therapy in patients with ER+/HER2- breast cancer and ctDNA relapse.

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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ER-positive Breast Cancer HER2-negative Breast Cancer Stage IIB Breast Cancer Stage III Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Experimental arm

elacestrant 400 mg/day orally once daily on a continuous dosing schedule

Group Type EXPERIMENTAL

Elacestrant

Intervention Type DRUG

400mg QD orally on a continuous dosing schedule

Control arm

standard endocrine treatment - the same they were receiving at the time of ctDNA detection

Group Type ACTIVE_COMPARATOR

Tamoxifen

Intervention Type DRUG

20 mg QD orally on a continuous dosing schedule

Letrozole 2.5mg

Intervention Type DRUG

2.5 mg QD orally on a continuous dosing schedule

Anastrozole 1mg

Intervention Type DRUG

1 mg QD orally on a continuous dosing schedule

Exemestane 25 MG

Intervention Type DRUG

25 mg QD orally on a continuous dosing schedule

Interventions

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Elacestrant

400mg QD orally on a continuous dosing schedule

Intervention Type DRUG

Tamoxifen

20 mg QD orally on a continuous dosing schedule

Intervention Type DRUG

Letrozole 2.5mg

2.5 mg QD orally on a continuous dosing schedule

Intervention Type DRUG

Anastrozole 1mg

1 mg QD orally on a continuous dosing schedule

Intervention Type DRUG

Exemestane 25 MG

25 mg QD orally on a continuous dosing schedule

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. ctDNA screening phase:


• 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

* Prior treatment with any SERD or investigational ER antagonist
* 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
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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European Organisation for Research and Treatment of Cancer - EORTC

NETWORK

Sponsor Role lead

Breast International Group

OTHER

Sponsor Role collaborator

Menarini Group

INDUSTRY

Sponsor Role collaborator

Responsible Party

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Responsibility Role SPONSOR

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

Site Status RECRUITING

AZ KLINA

Brasschaat, , Belgium

Site Status RECRUITING

Cliniques Universitaires Saint-Luc

Brussels, , Belgium

Site Status RECRUITING

Grand Hopital de Charleroi - Site Notre Dame

Charleroi, , Belgium

Site Status RECRUITING

CHU Helora Pole Hospitalier Jolimont - Hopital Jolimont

Haine-Saint-Paul, , Belgium

Site Status RECRUITING

AZ Groeninge Kortrijk - Campus Kennedylaan

Kortrijk, , Belgium

Site Status RECRUITING

U.Z. Leuven - Campus Gasthuisberg

Leuven, , Belgium

Site Status RECRUITING

CHU Site Sainte-Elisabeth-UCL Namur

Namur, , Belgium

Site Status RECRUITING

AZ Delta - Campus Rumbeke

Roeselare, , Belgium

Site Status RECRUITING

AZ Turnhout - Campus Sint Elisabeth

Turnhout, , Belgium

Site Status RECRUITING

Centre Hospitalier Regional Verviers

Verviers, , Belgium

Site Status RECRUITING

German Oncology Center

Limassol, , Cyprus

Site Status RECRUITING

Bank Of Cyprus Oncology Centre

Stróvolos, , Cyprus

Site Status RECRUITING

CH de La Cote Basque - Saint Leon

Bayonne, , France

Site Status RECRUITING

Clinique Belharra-Ramsay Sante

Bayonne, , France

Site Status RECRUITING

Centre de Radiotherapie Pierre Curie

Beuvry, , France

Site Status RECRUITING

Centre Hospitalier - Boulogne Sur Mer

Boulogne-sur-Mer, , France

Site Status RECRUITING

CHU de Lyon - Hopital Femme Mere Enfant

Bron, , France

Site Status RECRUITING

Societe de Recherche Oncologique Clinique 37

Chambray-lès-Tours, , France

Site Status RECRUITING

Hopital de Douai- Centre Leonard de Vinci

Dechy, , France

Site Status RECRUITING

CHU de Limoges - Hopital Dupuytren

Limoges, , France

Site Status RECRUITING

CHU de Lyon - Hopital De La Croix Rousse

Lyon, , France

Site Status RECRUITING

Polyclinique De Gentilly - Centre d'Oncologie

Nancy, , France

Site Status RECRUITING

CHU de Lyon - Hopital Lyon Sud

Pierre-Bénite, , France

Site Status RECRUITING

Institut Curie - l'Hopital de St Cloud

Saint-Cloud, , France

Site Status RECRUITING

CHU de Toulouse - Institut Claudius Regaud - IUCT oncopole

Toulouse, , France

Site Status RECRUITING

Universitaetsklinikum Aachen AOR - Medizinische Fakultaet der RWTH

Aachen, , Germany

Site Status RECRUITING

Gemeinschaftspraxis Augsburg

Augsburg, , Germany

Site Status RECRUITING

Evangelisches Krankenhaus -Bergisch Gladbach

Bergisch Gladbach, , Germany

Site Status RECRUITING

Marienhospital Bottrop gGmbH

Bottrop, , Germany

Site Status RECRUITING

Hamatologische Onkologische Praxis Im Medicum

Bremen, , Germany

Site Status RECRUITING

St Elisabeth-Krankenhaus

Cologne, , Germany

Site Status RECRUITING

Universitaetsklinikum Carl Gustav Carus (TUD)

Dresden, , Germany

Site Status RECRUITING

Medizinische Hochschule Hannover

Hanover, , Germany

Site Status RECRUITING

Gemeinschaftspraxis Dr. Pourfard / Dr. Uleer

Hildesheim, , Germany

Site Status RECRUITING

Klinikum Kassel Gmbh

Kassel, , Germany

Site Status RECRUITING

MVM MbH -Onkologie UnterEms, Leer-Papenburg-Emden

Leer, , Germany

Site Status RECRUITING

Busch MCZ GmbH

Mühlhausen, , Germany

Site Status RECRUITING

Klinikum Nuernberg- Standort Nord

Nuremberg, , Germany

Site Status RECRUITING

Klinikum Ernst von Bergmann gemeinnützige GmbH

Potsdam, , Germany

Site Status RECRUITING

Universitaetsklinikum Tuebingen-calwerstrasse

Tübingen, , Germany

Site Status RECRUITING

Universitaetsklinikum Ulm-Michelsberg

Ulm, , Germany

Site Status RECRUITING

HELIOS Kliniken - Helios Klinikum Wuppertal - Klin. Univ. Witten / Herdecke

Wuppertal, , Germany

Site Status RECRUITING

Diagnostic & Therapeutic Center of Athens Hygeia Hospital S.A.

Athens, , Greece

Site Status RECRUITING

General University Hospital of Larissa

Larissa, , Greece

Site Status RECRUITING

Mater Private Hospital

Dublin, , Ireland

Site Status RECRUITING

St. James'S Hospital

Dublin, , Ireland

Site Status RECRUITING

Beacon Hospital

Dublin, , Ireland

Site Status RECRUITING

Centro Di Riferimento Oncologico

Aviano, , Italy

Site Status RECRUITING

Azienda Ospedaliera Papa Giovanni XXIII

Bergamo, , Italy

Site Status RECRUITING

Univ. of Florence -Azienda Ospedaliero-Universitaria Careggi

Florence, , Italy

Site Status RECRUITING

IRCCS Azienda Policlinico San Martino

Genova, , Italy

Site Status RECRUITING

Azienda USL IRCCS Di Reggio Emilia Guastalla

Guastalla, , Italy

Site Status RECRUITING

Ospedale Alessandro Manzoni

Lecco, , Italy

Site Status RECRUITING

Azienda Unita Locale Socio-Sanitaria N. 9-Mater Salutis Hospital

Legnano, , Italy

Site Status RECRUITING

IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"

Meldola, , Italy

Site Status RECRUITING

University Hospital of Cagliari Duilio Casula Hospital Unit (Policlinico)

Monserrato, , Italy

Site Status RECRUITING

Azienda Ospedaliera Universitaria "Federico II"

Napoli, , Italy

Site Status RECRUITING

Azienda Ospedaliero-Universitaria di Parma

Parma, , Italy

Site Status RECRUITING

Istituti Clinici Scientifici Maugeri

Pavia, , Italy

Site Status RECRUITING

San Maria della Misericordia Hospital

Perugia, , Italy

Site Status RECRUITING

Azienda Ospedaliera Universitaria Pisana

Pisa, , Italy

Site Status RECRUITING

Azienda USL IRCCS Di Reggio Emilia - Maria Nuova

Reggio Emilia, , Italy

Site Status RECRUITING

AUSL Romagna - AUSL Della Romagna - Infermi Hospital -Rimini

Rimini, , Italy

Site Status RECRUITING

Flevoziekenhuis Stichting

Almere Stad, , Netherlands

Site Status RECRUITING

Amsterdam UMC - locatie VUMC

Amsterdam, , Netherlands

Site Status RECRUITING

Rijnstate Hospital

Arnhem, , Netherlands

Site Status RECRUITING

Haaglanden Medisch Centrum

Leidschendam, , Netherlands

Site Status RECRUITING

Ikazia Ziekenhuis

Rotterdam, , Netherlands

Site Status RECRUITING

Sint Antonius - St Antonius Ziekenhuis Utrecht

Utrecht, , Netherlands

Site Status RECRUITING

VieCuri - Medisch Centrum voor Noord-Limburg - Locatie Venlo

Venlo, , Netherlands

Site Status RECRUITING

Hospital General Universitario Doctor Balmis

Alicante, , Spain

Site Status RECRUITING

Hospital Universitario De Cruces

Barakaldo, , Spain

Site Status RECRUITING

Hospital Clinico Universitario - Virgen De La Arrixaca

El Palmar, , Spain

Site Status RECRUITING

ICO Girona - Hospital Doctor Josep Trueta

Girona, , Spain

Site Status RECRUITING

Hospital Universitario Virgen De Las Nieves

Granada, , Spain

Site Status RECRUITING

Hospital Universitario Clinico San Cecilio

Granada, , Spain

Site Status RECRUITING

ICO L'Hospitalet - Hospital Duran i Reynals

L'Hospitalet de Llobregat, , Spain

Site Status RECRUITING

Hospital Universitari Arnau De Vilanova

Lleida, , Spain

Site Status RECRUITING

Hospital Universitario 12 De Octubre

Madrid, , Spain

Site Status RECRUITING

Hospitales HM Sanchinarro-CIOCC

Madrid, , Spain

Site Status RECRUITING

Althaia Xarxa Assistencial Universitaria De Manresa Fundacio Privada

Manresa, , Spain

Site Status RECRUITING

Hospital Universitari Son Espases

Palma de Mallorca, , Spain

Site Status RECRUITING

Hospital Universitario de Navarra

Pamplona, , Spain

Site Status RECRUITING

Hospital Sant Joan de Reus

Reus, , Spain

Site Status RECRUITING

Hospital Quironsalud Sagrado Corazon

Seville, , Spain

Site Status RECRUITING

University Hospital Virgen del Rocio

Seville, , Spain

Site Status RECRUITING

Hospital Universitario Virgen De La Macarena

Seville, , Spain

Site Status RECRUITING

Hospital Clinico Universitario De Valencia

Valencia, , Spain

Site Status RECRUITING

Hospital Universitario Y Politecnico La Fe

Valencia, , Spain

Site Status RECRUITING

Sodra Alvsborgs Sjukhus - Vastra Gotalandsregionen

Borås, , Sweden

Site Status RECRUITING

Karolinska University Hospital, location Solna

Stockholm, , Sweden

Site Status RECRUITING

Kantonsspital Frauenfeld- Breast Unit Thurgau

Frauenfeld, , Switzerland

Site Status RECRUITING

Buergerspital Solothurn -Brustzentrum

Solothurn, , Switzerland

Site Status RECRUITING

Countries

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Belgium Cyprus France Germany Greece Ireland Italy Netherlands Spain Sweden Switzerland

Central Contacts

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EORTC HQ

Role: CONTACT

+32 2 774 16 11

Other Identifiers

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EORTC-2129-BCG

Identifier Type: -

Identifier Source: org_study_id

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