Phase II UK trial of ctDNA-guided early switch to fulvestrant + palbociclib in HR+/HER2- early breast cancer. 11.3% MRD detection rate; 42.9% concurrent recurrence.
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Trial slides shared by KOLs at ESMO Breast 2026 (#ESMOBreast26). Click any image to expand. OCR text extracted via AWS Textract.
Highest-engagement tweets about this trial, ranked by KOL discussant count (replies + quote-tweets). Replies in green, quote-tweets in blue. Wall Street, stock-promo, and non-substantive replies excluded.
ctDNA surveillance in HR+ breast cancer is promising… but here’s the reality 👇 #ESMOBreast26 🧬 TRAK-ER study 👥 High-risk HR+ / HER2- on adjuvant ET ⚡ Strategy: Serial ctDNA → detect relapse BEFORE imaging 📊 Key findings: • Detection per test: just 2.6% • 11.3% pts https://t.
Dr. Erica Mayer (@elmayermd) delivered an excellent discussion of the TRAK-ER and PREcoopERA trials at #ESMOBreast26. https://t.co/E8IQiBXcdB
Can ctDNA detect relapse before scans? 👀 #ESMOBreast26 TRAK-ER evaluated serial ctDNA surveillance in high-risk HR+/HER2- EBC. 🧬 ctDNA+ at first test (M0): • 65.9% already had recurrence 🧬 ctDNA+ later (M3+): • Only 26.2% had recurrence → Potential molecular lead-time https://
TRAK-ER Trial: Serial ctDNA Monitoring Uncovers Subclinical Relapse with Significant Lead-Time Advantage in High Risk HR+/HER2− Breast Cancer Moving from Radiologic Detection to Molecular Intervention @OncoAlert #ESMOBreast26 #bcsm #BreastCancer https://t.co/xRiz8DUXSb
#ESMOBreast26 In TRAK-ER, ctDNA positivity appeared to be associated more with nodal burden than with pT stage. At the time of ctDNA detection, 42.9% of patients already had recurrent disease; among those detected during M3+ surveillance, this rate decreased to 26.2%. ctDNA ht
TRAK-ER is a UK-led randomized multicentre study evaluating serial circulating tumor DNA (ctDNA) surveillance every 3 months for 3 years in patients with high-risk HR+/HER2- early breast cancer receiving adjuvant endocrine therapy. The primary aim is to detect molecular relapse before clinical or radiographic progression and randomize ctDNA-positive patients to palbociclib + fulvestrant vs. continued standard endocrine therapy. The interim surveillance analysis presented at ESMO Breast 2026 reports detection rates and clinical correlates from the first 480 patients with successful panel design.
Population: Patients with high-risk early-stage ER+/HER2- breast cancer (Allred 6/8+ ER, IHC 0/1+ HER2 or ISH-negative). High-risk defined by nodal status, tumour size >3 cm, grade 3, or high genomic risk (Oncotype DX RS≥26, Prosigna ≥60, EPclin ≥4.0, MammaPrint high). Currently 901 patients with successful panel design have started surveillance.
Interventions: Surveillance phase: tumour-informed ctDNA assay every 3 months. Treatment phase (post-randomization for ctDNA+ patients): palbociclib 125 mg/day 3 wks on/1 wk off + fulvestrant 500 mg IM monthly vs continued standard endocrine therapy.
Endpoints: Surveillance phase: ctDNA detection rate, lead time to clinical relapse, association with clinicopathologic features. Treatment phase primary: relapse-free survival.
Across 2,110 samples from 480 patients, ctDNA was detected in 2.6% of tests; 11.3% of patients had ctDNA detected at least once. Detection was higher at the first surveillance timepoint (Month 0: 6.2%) than later samples (Month 3+: 1.5%; p<0.0001). 42.9% of patients had concurrent metastatic disease at the time of initial ctDNA detection (65.9% at M0, 26.2% at M3+). Median allele fraction was 0.034%. Detection was numerically more frequent in higher-stage and node-positive disease. Annual detection rates declined over time: 7.6% Y1, 2.9% Y2-3, 1.8% Y4, 2.0% beyond Y7.
The interim surveillance analysis is observational — no treatment exposure. Panel design failed in 14.8-16.1% of patients (insufficient tumour material or detectable variants), highlighting need for more sensitive tumour-agnostic assays. Treatment phase safety (palbo + fulvestrant) is consistent with established profiles for those agents.
Rishabh Jain framed TRAK-ER as “ctDNA surveillance in HR+ breast cancer is promising… but here’s the reality,” noting “Detection per test: just 2.6%” and that detection “declines over time.” In a follow-up post he pressed the lead-time question: “ctDNA+ at first test (M0): 65.9% already had recurrence; ctDNA+ later (M3+): Only 26.2% had recurrence.” Yakup Ergün flagged that “ctDNA positivity appeared to be associated more with nodal burden than with pT stage,” and that “at the time of ctDNA detection, 42.9% of patients already had recurrent disease.” Aya Mohamed described the result as “Serial ctDNA Monitoring Uncovers Subclinical Relapse with Significant Lead-Time Advantage in High Risk HR+/HER2− Breast Cancer Moving from Radiologic Detection to Molecular Intervention.” Dana-Farber’s Breast Oncology Center noted that Erica Mayer “delivered an excellent discussion of the TRAK-ER and PREcoopERA trials,” setting up the open question of whether ctDNA-guided intervention can translate signal into outcome.
| Handle | Name | Sentiment | Tweet (excerpt) | Imp. |
|---|---|---|---|---|
| @DrRishabhOnco | Dr Rishabh Jain | Neutral | ctDNA surveillance in HR+ breast cancer is promising… but here’s the reality 👇 #ESMOBreast26 🧬 TRAK-ER study 👥 High-r… | 4,210 |
| @DrRishabhOnco | Dr Rishabh Jain | Neutral | Can ctDNA detect relapse before scans? 👀 #ESMOBreast26 TRAK-ER evaluated serial ctDNA surveillance in high-risk HR+/HER… | 2,251 |
| @DFCI_BreastOnc | Dana-Farber’s Breast Oncology Center | Neutral | Dr. Erica Mayer (@elmayermd) delivered an excellent discussion of the TRAK-ER and PREcoopERA trials at #ESMOBreast26. ht… | 785 |
| @dr_yakupergun | Yakup Ergün | Neutral | #ESMOBreast26 In TRAK-ER, ctDNA positivity appeared to be associated more with nodal burden than with pT stage. At the… | 764 |