NCT06562348

The ctDNA-RECIST Trial Part One

ctDNA Guided Palliative Systemic Therapy Compared to Standard Care in Metastatic Cancer - The Randomized ctDNA-RECIST Trial

• Status: Recruiting
• Phase: Phase 2
• Study type: Interventional
• Enrollment: 167 (estimated)
• Sponsor: Karen-Lise Garm Spindler · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

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

Detailed description

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

• Gastrointestinal Neoplasm

Interventions

Type	Name	Description
OTHER	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.
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.

Timeline

• Start date: 2025-01-15
• Primary completion: 2029-09-01
• Completion: 2030-09-01
• First posted: 2024-08-20
• Last updated: 2025-05-01

Locations

2 sites across 1 country: Denmark