The ctDNA-RECIST Trial Part One

NCT ID: NCT06562348

Last Updated: 2025-05-01

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

PHASE2

Total Enrollment

167 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-01-15

Study Completion Date

2030-09-01

Brief Summary

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A study investigating if analysis of circulating tumor DNA (ctDNA) can guide palliative treatment in patients with gastrointestinal cancer.

Detailed Description

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Background:

Circulating tumor DNA, (ctDNA) has the potential to better monitor treatment efficacy compared to imaging, possibly sparing the patient for ineffective treatment and their associated toxicity an allowing for an early change of the treatment approach.

Based on multiple dataset we have defined ctDNA-RECIST - the ctDNA response evaluation criteria.

Aim: This phase II randomized trial evaluates the use of ctDNA Response Evaluation Criteria in Solid Tumors (ctDNA-RECIST) versus standard imaging-based RECIST to guide treatment decisions in patients with metastatic gastrointestinal cancers.

Design: Patients are randomized 1:1. Patients in Arm A are offered standard treatment with response evaluation according to the RECIST criteria based on imaging, and treatment pauses according to institutional guidelines.

In Arm B, treatment response is evaluated based on change in ctDNA between the baseline sample and the evaluation and confirmation sample, according to ctDNA-RECIST:

* Progressive disease: An increase of ctDNA above the previous value with no overlap of the two CI's
* Stable disease: A value within CI of the previous value. The category also includes samples with both previous and present value being 0 (undetectable).
* Partial Response: A decrease below the previous value with no overlap of the two CI'S but the lower CI does not overlap 0.
* Complete response: Decreasing value to an undetectable level
* Near complete response: A decrease below the previous value with no overlap of the two CI'S and with the lower CI overlapping 0

Complete and near complete response can be combined and classified as maximal response.

The study is initiated as a feasibility study (part one)and will continue into the expansion trial after interim analysis.(part two)

Conditions

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Gastrointestinal Neoplasm

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

An open label 1:1 randomized phase II trial
Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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A: Standard of care

Response evaluation using imaging-based RECIST according to standard guidelines.

Group Type ACTIVE_COMPARATOR

Standard of care

Intervention Type OTHER

Patients will be offered palliative systemic treatment according to standard of care. Response evaluation will be performed with the imaging-based RECIST according to standard guidelines. Treatment pauses according to institutional guidelines. Blood samples will be analyzed retrospectively to evaluate ctDNA.

ctDNA-RECIST guided therapy approach

Response evaluation will be performed using ctDNA-RECIST instead of imaging.

Group Type EXPERIMENTAL

ctDNA-RECIST guided palliative systemic treatment

Intervention Type OTHER

Patients are offered palliative systemic treatment according to standard of care. Response evaluation will be performed using ctDNA-RECIST.

ctDNA is measured before start of treatment. If the baseline sample is ctDNA negative the patient is transferred to an observational cohort, and sampling procedures continues as in the standard arm. If the baseline sample is ctDNA positive the patient continues in the ctDNA-RECIST guided arm. Treatment response is evaluated according to ctDNA-RECIST, and further sampling follows a predefined decision schedule.

Interventions

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Standard of care

Patients will be offered palliative systemic treatment according to standard of care. Response evaluation will be performed with the imaging-based RECIST according to standard guidelines. Treatment pauses according to institutional guidelines. Blood samples will be analyzed retrospectively to evaluate ctDNA.

Intervention Type OTHER

ctDNA-RECIST guided palliative systemic treatment

Patients are offered palliative systemic treatment according to standard of care. Response evaluation will be performed using ctDNA-RECIST.

ctDNA is measured before start of treatment. If the baseline sample is ctDNA negative the patient is transferred to an observational cohort, and sampling procedures continues as in the standard arm. If the baseline sample is ctDNA positive the patient continues in the ctDNA-RECIST guided arm. Treatment response is evaluated according to ctDNA-RECIST, and further sampling follows a predefined decision schedule.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Incurable metastatic gastrointestinal cancer
* Indication for first or second-line systemic treatment
* Measurable disease according to RECIST v.1.1
* CT of chest and abdomen less than 30 days old at time of treatment initiation
* Age at least 18 years
* ECOG performance status 0-2
* Clinically eligible systemic palliative treatment at investigators decision.
* Adequate bone marrow, liver and renal function allowing systemic chemotherapy
* Anticonception for fertile women and for male patients with a fertile partner. Intrauterine device, vasectomy of a female subject's male partner or hormonal contraceptive are acceptable
* Written and verbally informed consent

Exclusion Criteria

* Incapacity, frailty, disability and comorbidity to a degree that according to the investigator is not compatible with combination chemotherapy
* Other concurrent malignant tumor except non-melanoma skin cancer or carcinoma in situ cervicis uteri
* Pregnant (positive pregnancy test) or breast-feeding women
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Vejle Hospital

OTHER

Sponsor Role collaborator

Karen-Lise Garm Spindler

OTHER

Sponsor Role lead

Responsible Party

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Karen-Lise Garm Spindler

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Karen-Lise G Spindler, MD, Prof

Role: PRINCIPAL_INVESTIGATOR

Department of Oncology, Aarhus University Hospital

Locations

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Aarhus University Hospital

Aarhus, , Denmark

Site Status RECRUITING

Department pf Oncology, Vejle Hospital

Vejle, , Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Karen-Lise G Spindler, MD, Prof

Role: CONTACT

+4591167244

Torben F Hansen, MD, Prof

Role: CONTACT

Facility Contacts

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Karen-Lise G Spindler

Role: primary

Torben F Hansen

Role: primary

Other Identifiers

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KFE 2406

Identifier Type: -

Identifier Source: org_study_id

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